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Read common questions on the coronavirus and ACOG’s evidence-based answers.

If Your Baby Is Breech

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Frequently Asked Questions Expand All

In the last weeks of pregnancy, a fetus usually moves so his or her head is positioned to come out of the vagina first during birth. This is called a vertex presentation . A breech presentation occurs when the fetus’s buttocks, feet, or both are in place to come out first during birth. This happens in 3–4% of full-term births.

It is not always known why a fetus is breech. Some factors that may contribute to a fetus being in a breech presentation include the following:

You have been pregnant before.

There is more than one fetus in the uterus (twins or more).

There is too much or too little amniotic fluid .

The uterus is not normal in shape or has abnormal growths such as fibroids .

The placenta covers all or part of the opening of the uterus ( placenta previa )

The fetus is preterm .

Occasionally fetuses with certain birth defects will not turn into the head-down position before birth. However, most fetuses in a breech presentation are otherwise normal.

Your health care professional may be able to tell which way your fetus is facing by placing his or her hands at certain points on your abdomen. By feeling where the fetus's head, back, and buttocks are, it may be possible to find out what part of the fetus is presenting first. An ultrasound exam or pelvic exam may be used to confirm it.

External cephalic version (ECV) is an attempt to turn the fetus so that he or she is head down. ECV can improve your chance of having a vaginal birth. If the fetus is breech and your pregnancy is greater than 36 weeks your health care professional may suggest ECV.

ECV will not be tried if:

You are carrying more than one fetus

There are concerns about the health of the fetus

You have certain abnormalities of the reproductive system

The placenta is in the wrong place

The placenta has come away from the wall of the uterus ( placental abruption )

ECV can be considered if you have had a previous cesarean delivery .

The health care professional performs ECV by placing his or her hands on your abdomen. Firm pressure is applied to the abdomen so that the fetus rolls into a head-down position. Two people may be needed to perform ECV. Ultrasound also may be used to help guide the turning.

The fetus's heart rate is checked with fetal monitoring before and after ECV. If any problems arise with you or the fetus, ECV will be stopped right away. ECV usually is done near a delivery room. If a problem occurs, a cesarean delivery can be performed quickly, if necessary.

Complications may include the following:

Prelabor rupture of membranes

Changes in the fetus's heart rate

Placental abruption

Preterm labor

More than one half of attempts at ECV succeed. However, some fetuses who are successfully turned with ECV move back into a breech presentation. If this happens, ECV may be tried again. ECV tends to be harder to do as the time for birth gets closer. As the fetus grows bigger, there is less room for him or her to move.

Most fetuses that are breech are born by planned cesarean delivery. A planned vaginal birth of a single breech fetus may be considered in some situations. Both vaginal birth and cesarean birth carry certain risks when a fetus is breech. However, the risk of complications is higher with a planned vaginal delivery than with a planned cesarean delivery.

In a breech presentation, the body comes out first, leaving the baby’s head to be delivered last. The baby’s body may not stretch the cervix enough to allow room for the baby’s head to come out easily. There is a risk that the baby’s head or shoulders may become wedged against the bones of the mother’s pelvis. Another problem that can happen during a vaginal breech birth is a prolapsed umbilical cord . It can slip into the vagina before the baby is delivered. If there is pressure put on the cord or it becomes pinched, it can decrease the flow of blood and oxygen through the cord to the baby.

Although a planned cesarean birth is the most common way that breech fetuses are born, there may be reasons to try to avoid a cesarean birth.

A cesarean delivery is major surgery. Complications may include infection, bleeding, or injury to internal organs.

The type of anesthesia used sometimes causes problems.

Having a cesarean delivery also can lead to serious problems in future pregnancies, such as rupture of the uterus and complications with the placenta.

With each cesarean delivery, these risks increase.

If you are thinking about having a vaginal birth and your fetus is breech, your health care professional will review the risks and benefits of vaginal birth and cesarean birth in detail. You usually need to meet certain guidelines specific to your hospital. The experience of your health care professional in delivering breech babies vaginally also is an important factor.

Amniotic Fluid : Fluid in the sac that holds the fetus.

Anesthesia : Relief of pain by loss of sensation.

Breech Presentation : A position in which the feet or buttocks of the fetus would appear first during birth.

Cervix : The lower, narrow end of the uterus at the top of the vagina.

Cesarean Delivery : Delivery of a fetus from the uterus through an incision made in the woman’s abdomen.

External Cephalic Version (ECV) : A technique, performed late in pregnancy, in which the doctor attempts to manually move a breech baby into the head-down position.

Fetus : The stage of human development beyond 8 completed weeks after fertilization.

Fibroids : Growths that form in the muscle of the uterus. Fibroids usually are noncancerous.

Oxygen : An element that we breathe in to sustain life.

Pelvic Exam : A physical examination of a woman’s pelvic organs.

Placenta : Tissue that provides nourishment to and takes waste away from the fetus.

Placenta Previa : A condition in which the placenta covers the opening of the uterus.

Placental Abruption : A condition in which the placenta has begun to separate from the uterus before the fetus is born.

Prelabor Rupture of Membranes : Rupture of the amniotic membranes that happens before labor begins. Also called premature rupture of membranes (PROM).

Preterm : Less than 37 weeks of pregnancy.

Ultrasound Exam : A test in which sound waves are used to examine inner parts of the body. During pregnancy, ultrasound can be used to check the fetus.

Umbilical Cord : A cord-like structure containing blood vessels. It connects the fetus to the placenta.

Uterus : A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus.

Vagina : A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body.

Vertex Presentation : A presentation of the fetus where the head is positioned down.

Article continues below

If you have further questions, contact your ob-gyn.

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Published: January 2019

Last reviewed: August 2022

Copyright 2024 by the American College of Obstetricians and Gynecologists. All rights reserved. Read copyright and permissions information . This information is designed as an educational aid for the public. It offers current information and opinions related to women's health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer .

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Breech Births

In the last weeks of pregnancy, a baby usually moves so his or her head is positioned to come out of the vagina first during birth. This is called a vertex presentation. A breech presentation occurs when the baby’s buttocks, feet, or both are positioned to come out first during birth. This happens in 3–4% of full-term births.

What are the different types of breech birth presentations?

Complete breech: Here, the buttocks are pointing downward with the legs folded at the knees and feet near the buttocks.
Frank breech: In this position, the baby’s buttocks are aimed at the birth canal with its legs sticking straight up in front of his or her body and the feet near the head.
Footling breech: In this position, one or both of the baby’s feet point downward and will deliver before the rest of the body.

What causes a breech presentation?

The causes of breech presentations are not fully understood. However, the data show that breech birth is more common when:

You have been pregnant before
In pregnancies of multiples
When there is a history of premature delivery
When the uterus has too much or too little amniotic fluid
When there is an abnormally shaped uterus or a uterus with abnormal growths, such as fibroids
The placenta covers all or part of the opening of the uterus placenta previa

How is a breech presentation diagnosed?

A few weeks prior to the due date, the health care provider will place her hands on the mother’s lower abdomen to locate the baby’s head, back, and buttocks. If it appears that the baby might be in a breech position, they can use ultrasound or pelvic exam to confirm the position. Special x-rays can also be used to determine the baby’s position and the size of the pelvis to determine if a vaginal delivery of a breech baby can be safely attempted.

Can a breech presentation mean something is wrong?

Even though most breech babies are born healthy, there is a slightly elevated risk for certain problems. Birth defects are slightly more common in breech babies and the defect might be the reason that the baby failed to move into the right position prior to delivery.

Can a breech presentation be changed?

It is preferable to try to turn a breech baby between the 32nd and 37th weeks of pregnancy . The methods of turning a baby will vary and the success rate for each method can also vary. It is best to discuss the options with the health care provider to see which method she recommends.

Medical Techniques

External Cephalic Version (EVC) is a non-surgical technique to move the baby in the uterus. In this procedure, a medication is given to help relax the uterus. There might also be the use of an ultrasound to determine the position of the baby, the location of the placenta and the amount of amniotic fluid in the uterus.

Gentle pushing on the lower abdomen can turn the baby into the head-down position. Throughout the external version the baby’s heartbeat will be closely monitored so that if a problem develops, the health care provider will immediately stop the procedure. ECV usually is done near a delivery room so if a problem occurs, a cesarean delivery can be performed quickly. The external version has a high success rate and can be considered if you have had a previous cesarean delivery.

ECV will not be tried if:

You are carrying more than one fetus
There are concerns about the health of the fetus
You have certain abnormalities of the reproductive system
The placenta is in the wrong place
The placenta has come away from the wall of the uterus ( placental abruption )

Complications of EVC include:

Prelabor rupture of membranes
Changes in the fetus’s heart rate
Placental abruption
Preterm labor

Vaginal delivery versus cesarean for breech birth?

Most health care providers do not believe in attempting a vaginal delivery for a breech position. However, some will delay making a final decision until the woman is in labor. The following conditions are considered necessary in order to attempt a vaginal birth:

The baby is full-term and in the frank breech presentation
The baby does not show signs of distress while its heart rate is closely monitored.
The process of labor is smooth and steady with the cervix widening as the baby descends.
The health care provider estimates that the baby is not too big or the mother’s pelvis too narrow for the baby to pass safely through the birth canal.
Anesthesia is available and a cesarean delivery possible on short notice

What are the risks and complications of a vaginal delivery?

In a breech birth, the baby’s head is the last part of its body to emerge making it more difficult to ease it through the birth canal. Sometimes forceps are used to guide the baby’s head out of the birth canal. Another potential problem is cord prolapse . In this situation the umbilical cord is squeezed as the baby moves toward the birth canal, thus slowing the baby’s supply of oxygen and blood. In a vaginal breech delivery, electronic fetal monitoring will be used to monitor the baby’s heartbeat throughout the course of labor. Cesarean delivery may be an option if signs develop that the baby may be in distress.

When is a cesarean delivery used with a breech presentation?

Most health care providers recommend a cesarean delivery for all babies in a breech position, especially babies that are premature. Since premature babies are small and more fragile, and because the head of a premature baby is relatively larger in proportion to its body, the baby is unlikely to stretch the cervix as much as a full-term baby. This means that there might be less room for the head to emerge.

Want to Know More?

Creating Your Birth Plan
Labor & Birth Terms to Know
Cesarean Birth After Care

Compiled using information from the following sources:

ACOG: If Your Baby is Breech
William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 24.
Danforth’s Obstetrics and Gynecology Ninth Ed. Scott, James R., et al, Ch. 21.

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Fetal Presentation, Position, and Lie (Including Breech Presentation)

Key Points |

Abnormal fetal lie or presentation may occur due to fetal size, fetal anomalies, uterine structural abnormalities, multiple gestation, or other factors. Diagnosis is by examination or ultrasonography. Management is with physical maneuvers to reposition the fetus, operative vaginal delivery , or cesarean delivery .

Terms that describe the fetus in relation to the uterus, cervix, and maternal pelvis are

Fetal presentation: Fetal part that overlies the maternal pelvic inlet; vertex (cephalic), face, brow, breech, shoulder, funic (umbilical cord), or compound (more than one part, eg, shoulder and hand)

Fetal position: Relation of the presenting part to an anatomic axis; for vertex presentation, occiput anterior, occiput posterior, occiput transverse

Fetal lie: Relation of the fetus to the long axis of the uterus; longitudinal, oblique, or transverse

Normal fetal lie is longitudinal, normal presentation is vertex, and occiput anterior is the most common position.

Abnormal fetal lie, presentation, or position may occur with

Fetopelvic disproportion (fetus too large for the pelvic inlet)

Fetal congenital anomalies

Uterine structural abnormalities (eg, fibroids, synechiae)

Multiple gestation

Several common types of abnormal lie or presentation are discussed here.

Transverse lie

Fetal position is transverse, with the fetal long axis oblique or perpendicular rather than parallel to the maternal long axis. Transverse lie is often accompanied by shoulder presentation, which requires cesarean delivery.

Breech presentation

There are several types of breech presentation.

Frank breech: The fetal hips are flexed, and the knees extended (pike position).

Complete breech: The fetus seems to be sitting with hips and knees flexed.

Single or double footling presentation: One or both legs are completely extended and present before the buttocks.

Types of breech presentations

Breech presentation makes delivery difficult ,primarily because the presenting part is a poor dilating wedge. Having a poor dilating wedge can lead to incomplete cervical dilation, because the presenting part is narrower than the head that follows. The head, which is the part with the largest diameter, can then be trapped during delivery.

Additionally, the trapped fetal head can compress the umbilical cord if the fetal umbilicus is visible at the introitus, particularly in primiparas whose pelvic tissues have not been dilated by previous deliveries. Umbilical cord compression may cause fetal hypoxemia.

Predisposing factors for breech presentation include

Preterm labor

Uterine abnormalities

Fetal anomalies

If delivery is vaginal, breech presentation may increase risk of

Umbilical cord prolapse

Birth trauma

Perinatal death

Face or brow presentation

In face presentation, the head is hyperextended, and position is designated by the position of the chin (mentum). When the chin is posterior, the head is less likely to rotate and less likely to deliver vaginally, necessitating cesarean delivery.

Brow presentation usually converts spontaneously to vertex or face presentation.

Occiput posterior position

The most common abnormal position is occiput posterior.

The fetal neck is usually somewhat deflexed; thus, a larger diameter of the head must pass through the pelvis.

Progress may arrest in the second phase of labor. Operative vaginal delivery or cesarean delivery is often required.

Position and Presentation of the Fetus

Toward the end of pregnancy, the fetus moves into position for delivery. Normally, the presentation is vertex (head first), and the position is occiput anterior (facing toward the pregnant patient's spine) with the face and body angled to one side and the neck flexed.

Abnormal presentations include face, brow, breech, and shoulder. Occiput posterior position (facing toward the pregnant patient's pubic bone) is less common than occiput anterior position.

If a fetus is in the occiput posterior position, operative vaginal delivery or cesarean delivery is often required.

In breech presentation, the presenting part is a poor dilating wedge, which can cause the head to be trapped during delivery, often compressing the umbilical cord.

For breech presentation, usually do cesarean delivery at 39 weeks or during labor, but external cephalic version is sometimes successful before labor, usually at 37 or 38 weeks.

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What happens if your baby is breech?

Babies often twist and turn during pregnancy, but most will have moved into the head-down (also known as head-first) position by the time labour begins. However, that does not always happen, and a baby may be:

bottom first or feet first (breech position)
lying sideways (transverse position)

Bottom first or feet first (breech baby)

If your baby is lying bottom or feet first, they are in the breech position. If they're still breech at around 36 weeks' gestation, the obstetrician and midwife will discuss your options for a safe delivery.

Turning a breech baby

If your baby is in a breech position at 36 weeks, you'll usually be offered an external cephalic version (ECV). This is when a healthcare professional, such as an obstetrician, tries to turn the baby into a head-down position by applying pressure on your abdomen. It's a safe procedure, although it can be a bit uncomfortable.

Giving birth to a breech baby

If an ECV does not work, you'll need to discuss your options for a vaginal birth or caesarean section with your midwife and obstetrician.

If you plan a caesarean and then go into labour before the operation, your obstetrician will assess whether it's safe to proceed with the caesarean delivery. If the baby is close to being born, it may be safer for you to have a vaginal breech birth.

The Royal College of Obstetricians and Gynaecologists (RCOG) website has more information on what to expect if your baby is still breech at the end of pregnancy .

The RCOG advises against a vaginal breech delivery if:

your baby's feet are below its bottom – known as a "footling breech"
your baby is larger or smaller than average – your healthcare team will discuss this with you
your baby is in a certain position – for example, their neck is very tilted back, which can make delivery of the head more difficult
you have a low-lying placenta (placenta praevia)
you have pre-eclampsia

Lying sideways (transverse baby)

If your baby is lying sideways across the womb, they are in the transverse position. Although many babies lie sideways early on in pregnancy, most turn themselves into the head-down position by the final trimester.

Giving birth to a transverse baby

Depending on how many weeks pregnant you are when your baby is in a transverse position, you may be admitted to hospital. This is because of the very small risk of the umbilical cord coming out of your womb before your baby is born (cord prolapse). If this happens, it's a medical emergency and the baby must be delivered very quickly.

Sometimes, it's possible to manually turn the baby to a head-down position, and you may be offered this.

But, if your baby is still in the transverse position when you approach your due date or by the time labour begins, you'll most likely be advised to have a caesarean section.

Video: My baby is breech. What help will I get?

In this video, a midwife describes what a breech position is and what can be done if your baby is breech.

Page last reviewed: 1 November 2023 Next review due: 1 November 2026

When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Breech presentation

Overview  
Theory  
Diagnosis  
Management  
Follow up  
Resources  

Breech presentation refers to the baby presenting for delivery with the buttocks or feet first rather than head.

Associated with increased morbidity and mortality for the mother in terms of emergency cesarean section and placenta previa; and for the baby in terms of preterm birth, small fetal size, congenital anomalies, and perinatal mortality.

Incidence decreases as pregnancy progresses and by term occurs in 3% to 4% of singleton term pregnancies.

Treatment options include external cephalic version to increase the likelihood of vaginal birth or a planned cesarean section, the optimal gestation being 37 and 39 weeks, respectively.

Planned cesarean section is considered the safest form of delivery for infants with a persisting breech presentation at term.

Breech presentation in pregnancy occurs when a baby presents with the buttocks or feet rather than the head first (cephalic presentation) and is associated with increased morbidity and mortality for both the mother and the baby. [1] Cunningham F, Gant N, Leveno K, et al. Williams obstetrics. 21st ed. New York: McGraw-Hill; 1997. [2] Kish K, Collea JV. Malpresentation and cord prolapse. In: DeCherney AH, Nathan L, eds. Current obstetric and gynecologic diagnosis and treatment. New York: McGraw-Hill Professional; 2002. There is good current evidence regarding effective management of breech presentation in late pregnancy using external cephalic version and/or planned cesarean section.

History and exam

Key diagnostic factors.

buttocks or feet as the presenting part
fetal head under costal margin
fetal heartbeat above the maternal umbilicus

Other diagnostic factors

subcostal tenderness
pelvic or bladder pain

Risk factors

premature fetus
small for gestational age fetus
nulliparity
fetal congenital anomalies
previous breech delivery
uterine abnormalities
abnormal amniotic fluid volume
placental abnormalities
female fetus

Diagnostic tests

1st tests to order.

transabdominal/transvaginal ultrasound

Treatment algorithm

<37 weeks' gestation and in labor, ≥37 weeks' gestation not in labor, ≥37 weeks' gestation in labor: no imminent delivery, ≥37 weeks' gestation in labor: imminent delivery, contributors, natasha nassar, phd.

Associate Professor

Menzies Centre for Health Policy

Sydney School of Public Health

University of Sydney

Disclosures

NN has received salary support from Australian National Health and a Medical Research Council Career Development Fellowship; she is an author of a number of references cited in this topic.

Christine L. Roberts, MBBS, FAFPHM, DrPH

Research Director

Clinical and Population Health Division

Perinatal Medicine Group

Kolling Institute of Medical Research

CLR declares that she has no competing interests.

Jonathan Morris, MBChB, FRANZCOG, PhD

Professor of Obstetrics and Gynaecology and Head of Department

JM declares that he has no competing interests.

Peer reviewers

John w. bachman, md.

Consultant in Family Medicine

Department of Family Medicine

Mayo Clinic

JWB declares that he has no competing interests.

Rhona Hughes, MBChB

Lead Obstetrician

Lothian Simpson Centre for Reproductive Health

The Royal Infirmary

RH declares that she has no competing interests.

Brian Peat, MD

Director of Obstetrics

Women's and Children's Hospital

North Adelaide

South Australia

BP declares that he has no competing interests.

Lelia Duley, MBChB

Professor of Obstetric Epidemiology

University of Leeds

Bradford Institute of Health Research

Temple Bank House

Bradford Royal Infirmary

LD declares that she has no competing interests.

Justus Hofmeyr, MD

Head of the Department of Obstetrics and Gynaecology

East London Private Hospital

East London

South Africa

JH is an author of a number of references cited in this topic.

Differentials

Transverse lie
Caesarean birth
Mode of term singleton breech delivery

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Pregnancy week by week
Fetal presentation before birth

The way a baby is positioned in the uterus just before birth can have a big effect on labor and delivery. This positioning is called fetal presentation.

Babies twist, stretch and tumble quite a bit during pregnancy. Before labor starts, however, they usually come to rest in a way that allows them to be delivered through the birth canal headfirst. This position is called cephalic presentation. But there are other ways a baby may settle just before labor begins.

Following are some of the possible ways a baby may be positioned at the end of pregnancy.

Head down, face down

When a baby is head down, face down, the medical term for it is the cephalic occiput anterior position. This the most common position for a baby to be born in. With the face down and turned slightly to the side, the smallest part of the baby's head leads the way through the birth canal. It is the easiest way for a baby to be born.

Head down, face up

When a baby is head down, face up, the medical term for it is the cephalic occiput posterior position. In this position, it might be harder for a baby's head to go under the pubic bone during delivery. That can make labor take longer.

Most babies who begin labor in this position eventually turn to be face down. If that doesn't happen, and the second stage of labor is taking a long time, a member of the health care team may reach through the vagina to help the baby turn. This is called manual rotation.

In some cases, a baby can be born in the head-down, face-up position. Use of forceps or a vacuum device to help with delivery is more common when a baby is in this position than in the head-down, face-down position. In some cases, a C-section delivery may be needed.

Illustration of the head-down, face-up position

Frank breech

When a baby's feet or buttocks are in place to come out first during birth, it's called a breech presentation. This happens in about 3% to 4% of babies close to the time of birth. The baby shown below is in a frank breech presentation. That's when the knees aren't bent, and the feet are close to the baby's head. This is the most common type of breech presentation.

If you are more than 36 weeks into your pregnancy and your baby is in a frank breech presentation, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. It involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a breech position, talk with a member of your health care team about the choices you have for delivery. Most babies in a frank breech position are born by planned C-section.

Illustration of the frank breech position

Complete and incomplete breech

A complete breech presentation, as shown below, is when the baby has both knees bent and both legs pulled close to the body. In an incomplete breech, one or both of the legs are not pulled close to the body, and one or both of the feet or knees are below the baby's buttocks. If a baby is in either of these positions, you might feel kicking in the lower part of your belly.

If you are more than 36 weeks into your pregnancy and your baby is in a complete or incomplete breech presentation, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. It involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a breech position, talk with a member of your health care team about the choices you have for delivery. Many babies in a complete or incomplete breech position are born by planned C-section.

Illustration of a complete breech presentation

When a baby is sideways — lying horizontal across the uterus, rather than vertical — it's called a transverse lie. In this position, the baby's back might be:

Down, with the back facing the birth canal.
Sideways, with one shoulder pointing toward the birth canal.
Up, with the hands and feet facing the birth canal.

Although many babies are sideways early in pregnancy, few stay this way when labor begins.

If your baby is in a transverse lie during week 37 of your pregnancy, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. External cephalic version involves one or two members of your health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a transverse lie, talk with a member of your health care team about the choices you have for delivery. Many babies who are in a transverse lie are born by C-section.

If you're pregnant with twins and only the twin that's lower in the uterus is head down, as shown below, your health care provider may first deliver that baby vaginally.

Then, in some cases, your health care team may suggest delivering the second twin in the breech position. Or they may try to move the second twin into a head-down position. This is done using a procedure called external cephalic version. External cephalic version involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

Your health care team may suggest delivery by C-section for the second twin if:

An attempt to deliver the baby in the breech position is not successful.
You do not want to try to have the baby delivered vaginally in the breech position.
An attempt to move the baby into a head-down position is not successful.
You do not want to try to move the baby to a head-down position.

In some cases, your health care team may advise that you have both twins delivered by C-section. That might happen if the lower twin is not head down, the second twin has low or high birth weight as compared to the first twin, or if preterm labor starts.

Landon MB, et al., eds. Normal labor and delivery. In: Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed May 19, 2023.
Holcroft Argani C, et al. Occiput posterior position. https://www.updtodate.com/contents/search. Accessed May 19, 2023.
Frequently asked questions: If your baby is breech. American College of Obstetricians and Gynecologists https://www.acog.org/womens-health/faqs/if-your-baby-is-breech. Accessed May 22, 2023.
Hofmeyr GJ. Overview of breech presentation. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
Strauss RA, et al. Transverse fetal lie. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
Chasen ST, et al. Twin pregnancy: Labor and delivery. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
Cohen R, et al. Is vaginal delivery of a breech second twin safe? A comparison between delivery of vertex and non-vertex second twins. The Journal of Maternal-Fetal & Neonatal Medicine. 2021; doi:10.1080/14767058.2021.2005569.
Marnach ML (expert opinion). Mayo Clinic. May 31, 2023.

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What Is Breech?

When a fetus is delivered buttocks or feet first

Types of Presentation

Risk Factors

Complications.

Breech concerns the position of the fetus before labor . Typically, the fetus comes out headfirst, but in a breech delivery, the buttocks or feet come out first. This type of delivery is risky for both the pregnant person and the fetus.

This article discusses the different types of breech presentations, risk factors that might make a breech presentation more likely, treatment options, and complications associated with a breech delivery.

Verywell / Jessica Olah

Types of Breech Presentation

During the last few weeks of pregnancy, a fetus usually rotates so that the head is positioned downward to come out of the vagina first. This is called the vertex position.

In a breech presentation, the fetus does not turn to lie in the correct position. Instead, the fetus’s buttocks or feet are positioned to come out of the vagina first.

At 28 weeks of gestation, approximately 20% of fetuses are in a breech position. However, the majority of these rotate to the proper vertex position. At full term, around 3%–4% of births are breech.

The different types of breech presentations include:

Complete : The fetus’s knees are bent, and the buttocks are presenting first.
Frank : The fetus’s legs are stretched upward toward the head, and the buttocks are presenting first.
Footling : The fetus’s foot is showing first.

Signs of Breech

There are no specific symptoms associated with a breech presentation.

Diagnosing breech before the last few weeks of pregnancy is not helpful, since the fetus is likely to turn to the proper vertex position before 35 weeks gestation.

A healthcare provider may be able to tell which direction the fetus is facing by touching a pregnant person’s abdomen. However, an ultrasound examination is the best way to determine how the fetus is lying in the uterus.

Most breech presentations are not related to any specific risk factor. However, certain circumstances can increase the risk for breech presentation.

These can include:

Previous pregnancies
Multiple fetuses in the uterus
An abnormally shaped uterus
Uterine fibroids , which are noncancerous growths of the uterus that usually appear during the childbearing years
Placenta previa, a condition in which the placenta covers the opening to the uterus
Preterm labor or prematurity of the fetus
Too much or too little amniotic fluid (the liquid that surrounds the fetus during pregnancy)
Fetal congenital abnormalities

Most fetuses that are breech are born by cesarean delivery (cesarean section or C-section), a surgical procedure in which the baby is born through an incision in the pregnant person’s abdomen.

In rare instances, a healthcare provider may plan a vaginal birth of a breech fetus. However, there are more risks associated with this type of delivery than there are with cesarean delivery.

Before cesarean delivery, a healthcare provider might utilize the external cephalic version (ECV) procedure to turn the fetus so that the head is down and in the vertex position. This procedure involves pushing on the pregnant person’s belly to turn the fetus while viewing the maneuvers on an ultrasound. This can be an uncomfortable procedure, and it is usually done around 37 weeks gestation.

ECV reduces the risks associated with having a cesarean delivery. It is successful approximately 40%–60% of the time. The procedure cannot be done once a pregnant person is in active labor.

Complications related to ECV are low and include the placenta tearing away from the uterine lining, changes in the fetus’s heart rate, and preterm labor.

ECV is usually not recommended if the:

Pregnant person is carrying more than one fetus
Placenta is in the wrong place
Healthcare provider has concerns about the health of the fetus
Pregnant person has specific abnormalities of the reproductive system

Recommendations for Previous C-Sections

The American College of Obstetricians and Gynecologists (ACOG) says that ECV can be considered if a person has had a previous cesarean delivery.

During a breech delivery, the umbilical cord might come out first and be pinched by the exiting fetus. This is called cord prolapse and puts the fetus at risk for decreased oxygen and blood flow. There’s also a risk that the fetus’s head or shoulders will get stuck inside the mother’s pelvis, leading to suffocation.

Complications associated with cesarean delivery include infection, bleeding, injury to other internal organs, and problems with future pregnancies.

A healthcare provider needs to weigh the risks and benefits of ECV, delivering a breech fetus vaginally, and cesarean delivery.

In a breech delivery, the fetus comes out buttocks or feet first rather than headfirst (vertex), the preferred and usual method. This type of delivery can be more dangerous than a vertex delivery and lead to complications. If your baby is in breech, your healthcare provider will likely recommend a C-section.

A Word From Verywell

Knowing that your baby is in the wrong position and that you may be facing a breech delivery can be extremely stressful. However, most fetuses turn to have their head down before a person goes into labor. It is not a cause for concern if your fetus is breech before 36 weeks. It is common for the fetus to move around in many different positions before that time.

At the end of your pregnancy, if your fetus is in a breech position, your healthcare provider can perform maneuvers to turn the fetus around. If these maneuvers are unsuccessful or not appropriate for your situation, cesarean delivery is most often recommended. Discussing all of these options in advance can help you feel prepared should you be faced with a breech delivery.

American College of Obstetricians and Gynecologists. If your baby is breech .

TeachMeObGyn. Breech presentation .

MedlinePlus. Breech birth .

Hofmeyr GJ, Kulier R, West HM. External cephalic version for breech presentation at term . Cochrane Database Syst Rev . 2015 Apr 1;2015(4):CD000083. doi:10.1002/14651858.CD000083.pub3

By Christine Zink, MD Dr. Zink is a board-certified emergency medicine physician with expertise in the wilderness and global medicine.

This page has been automatically translated by Google Translate. Please check with your medical team before acting on any health information. Email [email protected] with any feedback.

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What happens if my baby is breech, what does breech mean.

When a baby is upright, with their bottom or feet low down in the womb, they are in a breech position. This is common in early pregnancy.

Most babies that are breech will turn themselves by about 36 to 37 weeks, so that they are head-down, ready for birth. This is the best position for a baby to be in near the end of pregnancy.

Sometimes, though, babies do not turn head-down. Around 3 to 4 babies in every 100 remain breech.

What are the different breech positions?

There are three main breech positions:

Extended or frank breech

Your baby is bottom first, with their thighs pressed against their tummy and chest, and their feet up by their ears. Most breech babies are in this position.

Footling breech

Your baby is feet first. Either one or both feet are below their bottom.

Flexed breech

Your baby is bottom first, with their knees bent, thighs against their chest, and their feet next to their bottom.

Why is my baby breech?

For some people having a breech is just down to chance. Certain factors do make it more likely, for example:

it's your first pregnancy
there is too little amniotic fluid (oligohydramnios) around your baby
you are pregnant with more than one baby
you have a a low lying placenta (placenta praevia).

Is a breech birth more difficult?

Vaginal breech birth can be complicated. That’s partly because the baby's head, which is the biggest part of their body, comes out last. This can lead to problems, such as them not getting enough oxygen during the birth.

But if your baby's bottom is coming first, rather than their foot or knee, vaginal birth is more likely to run smoothly.

Being cared for in hospital, by a team experienced in breech vaginal birth, is the safest option for you and your baby. That’s why your midwife or doctor will talk to you about your birth options at 36 weeks of pregnancy if your baby is in a breech position.

There are benefits and risks with both caesarean section and vaginal breech birth, which they will discuss with you so that you can choose what is best for you and your baby.

What happens if my baby stays breech?

If a scan shows that your baby is still breech at 36 weeks your midwife or doctor will explain your options. These are:

They can try to turn your baby around in your womb using a technique called external cephalic version (ECV).
You can have a planned caesarean birth.
You can have a planned vaginal breech birth.

What is an external cephalic version (ECV)?

An ECV involves a specially trained midwife or doctor pressing firmly but gently on your belly. The pressure may help your baby to turn to a head-down position. Your chances of having a vaginal birth are higher if your baby is head-down.

Your midwife or doctor will check your blood pressure before trying an ECV, as well as your baby's heart rate. If all is well they will give you an injection of medicine to relax your womb muscles. It may push your heart rate up for a short while and you may feel flushed.

An ECV only lasts a few minutes, but it can be uncomfortable. If you are in pain, tell the person carrying out the ECV, and they will stop.

ECV is safe for people who are having a straightforward pregnancy. It turns half of breech babies. You will have a scan after the ECV to see if it has worked for your baby.

If the ECV does not work the first time your midwife or doctor may offer to try again on a different day.

"I was absolutely petrified (crying before they'd even started), but the consultant and midwife were brill and turned her within a couple of minutes. She went on to be 1.5 weeks overdue and I had a completely natural birth at our midwife-led unit." Emma

Is everyone offered an ECV?

An ECV does not suit everyone. You will not be offered an ECV if:

if you need a caesarean section for another reason, such as a low-lying placenta
you have had recent vaginal bleeding
there is concern about your baby’s heart rate
your waters have broken
you are pregnant with more than one baby .

Watch this short video from the NHS about ECVs

Is there anything I can try to help turn my baby?

There are a couple of other things you could try, but there’s no guarantee they will work.

Stretches and positions

There is no proof that getting into certain positions turns a breech baby, but some people say it worked for them.

As long as it is comfy for you, kneel on a mat with your head down to the floor and your bottom raised up, for about 15-20 minutes each day. The aim is to get your baby out of your pelvis to give them more room to turn.

If you feel any pain, or start to get dizzy, stop straight away.

A simpler option could be lying on your side (lateral position). One small study suggests that lying on your right side several times a day if your baby's back is on the left side, or lying on your left side if your baby's back is on the right side, may help your baby to turn to a head-down position.

Moxibustion

Moxibustion is an alternative therapy that uses Chinese herbal medicine and acupuncture points. A practitioner burns a stick of the dried herb mugwort (moxa) over certain acupuncture points on the body. There is no contact with the skin.

The idea is that moxibustion at 33 to 35 weeks of pregnancy can stimulate hormones and womb muscles, and therefore encourage your baby to move.

There is some evidence that moxibustion works, but more proof is needed to be sure.

You can do moxibustion yourself once a trained, registered practitioner has shown you how to do it. Talk to your midwife or doctor before trying moxibustion or any other alternative therapy.

Chiropractic

A chiropractic technique called the Webster method claims to help breech babies to turn. A chiropractor using this method, will aim to manually adjust certain parts of your lower body to realign your pelvis. The idea is that this helps your baby to get into the best position for birth.

Some mums say the technique has helped them, but it is unproven. Research into its safety is limited, too. It’s best to talk to your midwife if this is something you’re tempted to try.

How will I give birth to my breech baby?

Your midwife or doctor will explain your birth options if your baby stays breech towards the end of your pregnancy. They will talk you through the risks and benefits of a caesarean birth compared with a vaginal birth.

They should explain that, while a caesarean is safer for your baby, a vaginal birth may be safer for you. Each pregnancy is different. Your healthcare team should support you to make the decision that is best for you and your baby.

Planned caesarean section

Your healthcare professional will advise you to have a planned caesarean section if:

your baby is footling breech (feet first)
your baby is larger or smaller than average
your baby's neck is in an awkward position, for example, tilted back
you have a low-lying placenta
you have other pregnancy complications, such as pre-eclampsia.

A planned caesarean means you will have a set day and time to arrive at the hospital to have your baby.

" had an amazing birth experience and couldn't thank the midwives and surgical team enough for all the help and support." Ruth. Read more about Ruth's breech birth story.

Some people go into labour before their planned caesarean date. If this happens to you, your midwife or doctor will ask to examine you, to see if it would be best for you to have an emergency caesarean. Sometimes, if your baby is nearly ready to be born, they will advise you to have a vaginal birth after all.

Planned vaginal breech birth

If you decide to have a vaginal breech birth, your midwife and doctor will explain how it may affect you and your baby, taking into account your pregnancy history. They will advise you to include the possibility of a caesarean in your birth plan .

It is helpful to think about this in advance. That’s because 4 in 10 people who choose a vaginal breech birth go on to have a caesarean.

When you go into labour, a breech birth team will care for you in a hospital maternity unit. The team will include midwives and doctors who have supported other people through vaginal breech births.

You will have the same pain relief options as someone giving birth to a head-down baby. That includes an epidural.

Although there may be more staff on hand to look after you, they should still create a calm, supportive space for you to labour and give birth.

Where can I find out more about breech births?

Download the Breech baby at the end of pregnancy leaflet from the Royal College of Obstetricians & Gynaecologists (RCOG).

Find out more about positions for birth .

Curnow, E and Geraghty, S (2019) Chiropractic care of the pregnant woman and neonate. British Journal of Midwifery. 2019 May;27(5). https://www.britishjournalofmidwifery.com/content/clinical-practice/chiropractic-care-of-the-pregnant-woman-and-neonate/

Hofmeyr G, Hannah M et al (2015) Planned caesarean section for term breech delivery. Cochrane Database Syst Rev. 2015 Jul 21;2015(7):CD000166. doi: 10.1002/14651858.CD000166.pub2

Miranda-Garcia M et al (2019) Effectiveness and Safety of Acupuncture and Moxibustion in Pregnant Women with Noncephalic Presentation: An Overview of Systematic Reviews. Evid Based Complement Alternat Med. 3;2019:7036914. doi: 10.1155/2019/7036914.

NHS. What happens if your baby is breech? Available at: https://www.nhs.uk/pregnancy/labour-and-birth/what-happens/if-your-baby-is-breech/ (Page last reviewed: 1 November 2023. Next review due: 1 November 2026)

NICE (2021). Caesarean birth: NICE guideline 192. National Institute for health and care excellence https://www.nice.org.uk/guidance/ng192/resources/caesarean-birth-pdf-66142078788805

RCOG (2022). Breech baby at the end of pregnancy. Royal College of Obstetricians and Gynaecologists https://www.rcog.org.uk/for-the-public/browse-all-patient-information-leaflets/breech-baby-at-the-end-of-pregnancy-patient-information-leaflet/

Shinmura H, Matsushima T et al (2022) Cephalic version by postural management in the lateral position without the knee-chest position for primiparous breech presentation: A retrospective cohort study. J Obstet Gynaecol Res. 2022 Mar;48(3):703-708. doi: 10.1111/jog.15149

Tiran D (2015) The essential guide to using complementary therapies during pregnancy. https://www.expectancy.co.uk/Content/Media/PDFs/USING_COMPLEMENTARY_THERAPIES_IN_PREGNANCY_E-BOOK.pdf

Review dates

Fetal Presentation, Position, and Lie (Including Breech Presentation)

Variations in Fetal Position and Presentation |

During pregnancy, the fetus can be positioned in many different ways inside the mother's uterus. The fetus may be head up or down or facing the mother's back or front. At first, the fetus can move around easily or shift position as the mother moves. Toward the end of the pregnancy the fetus is larger, has less room to move, and stays in one position. How the fetus is positioned has an important effect on delivery and, for certain positions, a cesarean delivery is necessary. There are medical terms that describe precisely how the fetus is positioned, and identifying the fetal position helps doctors to anticipate potential difficulties during labor and delivery.

Presentation refers to the part of the fetus’s body that leads the way out through the birth canal (called the presenting part). Usually, the head leads the way, but sometimes the buttocks (breech presentation), shoulder, or face leads the way.

Position refers to whether the fetus is facing backward (occiput anterior) or forward (occiput posterior). The occiput is a bone at the back of the baby's head. Therefore, facing backward is called occiput anterior (facing the mother’s back and facing down when the mother lies on her back). Facing forward is called occiput posterior (facing toward the mother's pubic bone and facing up when the mother lies on her back).

Lie refers to the angle of the fetus in relation to the mother and the uterus. Up-and-down (with the baby's spine parallel to mother's spine, called longitudinal) is normal, but sometimes the lie is sideways (transverse) or at an angle (oblique).

For these aspects of fetal positioning, the combination that is the most common, safest, and easiest for the mother to deliver is the following:

Head first (called vertex or cephalic presentation)

Facing backward (occiput anterior position)

Spine parallel to mother's spine (longitudinal lie)

Neck bent forward with chin tucked

Arms folded across the chest

If the fetus is in a different position, lie, or presentation, labor may be more difficult, and a normal vaginal delivery may not be possible.

Variations in fetal presentation, position, or lie may occur when

The fetus is too large for the mother's pelvis (fetopelvic disproportion).

The uterus is abnormally shaped or contains growths such as fibroids .

The fetus has a birth defect .

There is more than one fetus (multiple gestation).

Position and Presentation of the Fetus

Toward the end of pregnancy, the fetus moves into position for delivery. Normally, the presentation is vertex (head first), and the position is occiput anterior (facing toward the pregnant person's spine) and with the face and body angled to one side and the neck flexed.

Variations in fetal presentations include face, brow, breech, and shoulder. Occiput posterior position (facing forward, toward the mother's pubic bone) is less common than occiput anterior position (facing backward, toward the mother's spine).

Variations in Fetal Position and Presentation

Some variations in position and presentation that make delivery difficult occur frequently.

Occiput posterior position

In occiput posterior position (sometimes called sunny-side up), the fetus is head first (vertex presentation) but is facing forward (toward the mother's pubic bone—that is, facing up when the mother lies on her back). This is a very common position that is not abnormal, but it makes delivery more difficult than when the fetus is in the occiput anterior position (facing toward the mother's spine—that is facing down when the mother lies on her back).

When a fetus faces up, the neck is often straightened rather than bent,which requires more room for the head to pass through the birth canal. Delivery assisted by a vacuum device or forceps or cesarean delivery may be necessary.

Breech presentation

In breech presentation, the baby's buttocks or sometimes the feet are positioned to deliver first (before the head).

When delivered vaginally, babies that present buttocks first are more at risk of injury or even death than those that present head first.

The reason for the risks to babies in breech presentation is that the baby's hips and buttocks are not as wide as the head. Therefore, when the hips and buttocks pass through the cervix first, the passageway may not be wide enough for the head to pass through. In addition, when the head follows the buttocks, the neck may be bent slightly backwards. The neck being bent backward increases the width required for delivery as compared to when the head is angled forward with the chin tucked, which is the position that is easiest for delivery. Thus, the baby’s body may be delivered and then the head may get caught and not be able to pass through the birth canal. When the baby’s head is caught, this puts pressure on the umbilical cord in the birth canal, so that very little oxygen can reach the baby. Brain damage due to lack of oxygen is more common among breech babies than among those presenting head first.

In a first delivery, these problems may occur more frequently because a woman’s tissues have not been stretched by previous deliveries. Because of risk of injury or even death to the baby, cesarean delivery is preferred when the fetus is in breech presentation, unless the doctor is very experienced with and skilled at delivering breech babies or there is not an adequate facility or equipment to safely perform a cesarean delivery.

Breech presentation is more likely to occur in the following circumstances:

Labor starts too soon (preterm labor).

The uterus is abnormally shaped or contains abnormal growths such as fibroids .

What does it mean for my baby?

The birth process is often more challenging if your baby is in a breech position at the start of labour . A vaginal birth can be more risky for your baby. Your doctor or midwife may advise you to have a caesarean birth, especially if your baby is in a footling breech position.

If your baby is born in a breech position, they have a higher risk of developmental dysplasia of the hip (DDH) , when your baby’s hip doesn’t develop normally. They should have an ultrasound of their hips after six weeks of age to check for this.

Why might my baby remain in a breech position?

Often, it is unclear why a baby stays in a breech position. Some of the common causes include:

too much or too little amniotic fluid around the baby
a short umbilical cord
a low-lying placenta
many previous pregnancies, making the muscles of the uterus more floppy
multiple pregnancy
uterine fibroids
an irregular size or shape of your uterus

Can my baby still turn after 36 weeks?

Some breech babies turn themselves naturally in the last month of pregnancy. The chance of this happening gets lower as time goes on.

If your baby is in a breech position at 36 weeks, your doctor or midwife might suggest you an ECV, or external cephalic version after 37 weeks . This procedure tries to turn breech babies to the head-down position, ready for a normal vaginal birth. However, ECV is not suitable for everyone, so it’s important to discuss this option with your doctor or midwife.

Is there anything else I can do to make my baby turn?

Some people think that you might be able to encourage your baby to turn by holding yourself in certain positions, such as kneeling with your bottom in the air and your head and shoulders flat to the ground. Other options you might hear include acupuncture, a Chinese herb called moxibustion and chiropractic treatment. There is no good evidence that these work.

Talk to your doctor or midwife before trying any techniques, to check if they might harm you or your baby.

What are my birth options if my baby is breech?

If your baby does not turn, you will have 2 options:

planning an elective caesarean birth
trying to have a vaginal breech birth

Most breech babies are born by caesarean. You may be able to have a vaginal birth with a breech baby, but you will need to go to a hospital that can offer you and your baby specialised care.

If your baby is breech, an elective (planned) caesarean is safer for your baby than a vaginal birth in the short term. However, in the longer term their health will be similar, on average, regardless of how they were born.

A vaginal birth is safer for you than an elective caesarean. However, about 4 in 10 people planning a vaginal breech birth end up needing an emergency caesarean . If this happens to you, your risk of complications will be higher.

Your obstetrician . or midwife can talk about your options with you. Whether it’s safe for you to try a vaginal birth will depend on many factors, such as how big your baby is, the exact position of your baby, where the placenta is, the structure of your pelvis and whether you’ve had a caesarean in the past.

What are the safety risks of a vaginal breech birth?

If your baby is being born bottom-first, their largest part — their head — is the last to come out. There is a chance that their head or arms may not follow easily once their body is born.

Risks to your baby can include:

Erb’s palsy (damage the nerves in your baby’s shoulder and /or arm)
fractures, dislocations or other injuries
bleeding in your baby’s brain
low Apgar scores
their head getting stuck — this is an emergency

If your waters break when your baby is not head-first, there is a higher risk of cord prolapse . This is an emergency.

If you feel your waters break and you have been told that your baby is not head-first, seek medical help immediately.

What is involved in a vaginal breech birth?

It is important that a midwife or obstetrician with skills and experience in vaginal breech births is with you to help you birth your baby.

Your baby’s heart rate should be monitored continuously with a cardiotocograph (CTG) . You may want to ask your doctor or midwife if you can use a cordless, waterproof CTG so you can remain upright and mobile, and so you can use the bath or shower for pain management during labour.

You will be able to choose what pain relief you have.

Giving birth in an upright position is recommended with a breech baby, however you may need to give birth in a different position if your obstetrician or midwife has more experience with it.

Your obstetrician or midwife will be close by and can help guide your baby into the best position for birth if needed. If your progress during labour slows down, there are a number of techniques they can use to assist your baby to be born vaginally. However, sometimes it may be necessary to have an emergency caesarean section.

Can I have a vaginal breech birth at any hospital?

No. Not all hospitals have obstetricians and midwives on staff with the skills and experience in assisting with a vaginal breech birth. If it is important to you to have a vaginal breech birth and your doctor, midwife or hospital don’t offer this option, you can ask them to refer you to another health service.

What should I ask my doctor or midwife?

It is worth discussing whether you can have an ECV, because if this is successful, you can go on to try a vaginal birth that is safer and more straightforward.

You should also ask if:

a vaginal birth is safe for the type of breech position your baby is in
the health service you are planning to use can manage a vaginal breech birth
your doctor or midwife has training and experience in managing a vaginal breech birth

What if I am planning a home birth and my baby is breech?

If you are planning a home birth , discuss options for your care with your midwife. A planned homebirth is only considered safe if your baby is head-first.

If your baby is breech when you go into labour, it is safest to give birth at a hospital with staff experienced in supporting vaginal breech births and facilities for an emergency caesarean.

Your midwife may be able to continue supporting you during your birth in hospital and after you go home. This will depend on the arrangement between your midwife and the hospital.

Speak to a maternal child health nurse

Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call . Available 7am to midnight (AET), 7 days a week.

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Last reviewed: September 2022

External cephalic version (ecv), search our site for.

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Foetal Version

Need more information?

Breech Presentation at the End of your Pregnancy

Breech presentation occurs when your baby is lying bottom first or feet first in the uterus (womb) rather than the usual head first position. In early pregnancy, a breech position is very common.

Read more on RANZCOG - Royal Australian and New Zealand College of Obstetricians and Gynaecologists website

External Cephalic Version for Breech Presentation - Pregnancy and the first five years

This information brochure provides information about an External Cephalic Version (ECV) for breech presentation

Breech presentation and turning the baby

In preparation for a safe birth, your health team will need to turn your baby if it is in a bottom first ‘breech’ position.

Presentation and position of baby through pregnancy and at birth

Presentation and position refer to where your baby’s head and body is in relation to your birth canal. Learn why it’s important for labour and birth.

Read more on Pregnancy, Birth & Baby website

Malpresentation

Malpresentation is when your baby is in an unusual position as the birth approaches. It may be possible to move the baby, but a caesarean may be safer.

Labour complications

Even if you’re healthy and well prepared for childbirth, there’s always a chance of unexpected problems. Learn more about labour complications.

Breech Baby at Term Information about care options - Pregnancy and the first five years

Breech Baby at Term Information about care options

ECV is a procedure to try to move your baby from a breech position to a head-down position. This is performed by a trained doctor.

Complications of pregnancy

Read this article to learn more about possible complications in pregnancy.

Anatomy of pregnancy and birth - pelvis

Your pelvis helps to carry your growing baby and is tailored for vaginal births. Learn more about the structure and function of the female pelvis.

Pregnancy, Birth and Baby is not responsible for the content and advertising on the external website you are now entering.

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Can You Turn a Breech Baby?

There are some things you can do to encourage your breech baby to turn, from sleeping position to exercises and more. Learn more from the experts here.

Can You Use Sleeping Positions Turn a Breech Baby?

Can you turn a breech baby with exercise, other ways to turn a breech baby.

What Happens if My Breech Baby Doesn't Turn?

As you approach your due date, your body does many things to prepare for childbirth , ranging from Braxton Hicks contractions to the descent of your baby, which is also known as when your baby "drops." Most of the time, a baby will descend with their head pointed toward the vagina, which is also known as vertex positioning; however, sometimes, a baby will be positioned with their buttocks and/or feet first, which is known as breech presentation.

"A breech baby is a baby who's buttocks, feet, or both are positioned to come out first, rather than the baby's head," elaborates Dr. Renita White, MD, an Atlanta-based OB-GYN. "This occurs in 3 to 4% of full-term pregnancies, as most babies are delivered head first.'"

While some breech babies can be delivered vaginally, it's only considered safe in very specific circumstances. Many health care providers will opt to perform a C-section for a feet-first or buttocks-first infant; this decreases the odds of complications. Others will recommend various procedures and methods to try and get the baby to turn before labor begins.

It's important to note that not all babies stay breech. Some turn around on their own before delivery. You can actually do some things to help move your little love bug along, though they aren't guaranteed to work. Ahead are some exercises, sleeping positions, and activities that might help coax your baby into the head down position, along with additional options that your health care provider might suggest.

Every pregnancy is different, and every baby is different. Be sure to speak with an OB-GYN, midwife, or health care provider before attempting any techniques to turn a breech baby, and reach out to a provider with any additional questions or concerns you have about your baby's positioning.

While there's no scientific evidence that supports any specific sleeping position as a method for turning a breech baby, some experts suggest trying to sleep on your side with a pillow between your legs in order to give your baby more "room. If nothing else, this position might also offer you relief if you're experiencing any aches or pains in your lower back or legs. And if you're late in the pregnancy game, you're probably already sleeping on your side. After all, sleeping on your stomach is uncomfortable and sleeping on your back is generally considered unsafe.

Some exercises can help a breech baby turn naturally. "Certain postural maneuvers may help to facilitate spontaneous repositioning of a baby from breech to the head-down position," says Dr. White.

Pelvic tilts may encourage your baby to turn, particularly if they are already moving. Inversions, like child's pose, can relax the pelvic muscles and uterus while using gravity. What's more, walking encourages movement while loosening the tissues and connective tissue that supports the uterus and pelvis. Activities like kneeling and lunging may also be beneficial; however, be sure to discuss any exercise or physical movement with an OB-GYN or health care provider.

Swimming often feels really good at the end of pregnancy due to the buoyancy provided by the water, which can also help to take pressure off the body to provide more room for the baby. The breaststroke and crawl can be very beneficial in getting the baby to move.

While there is no tried-and-true way to turn a breech baby, your health care provider might suggest trying the following things.

If you find your baby reacts to sound or music, you may want to try playing a tune for them. Sometimes a simple melody will get them moving and grooving.

Acupuncture with moxibustion

Since acupuncture alleviates pressure, this ancient practice may help relax the muscles of your pelvis and uterus. Licensed practitioners also combine it with moxibustion, which involves burning the herb mugwort (or moxa) near acupuncture points, to turn a breech baby. Some studies have found acupuncture with moxibustion is effective for turning breech babies; however, be sure to consult a health care provider before attempting this method.

Heat and Cold

The strategy for using heat and cold is to put cold near where the baby’s head is currently (at the top of the uterus) and warmth where you want the head to go (near the bottom of the uterus). Even in the womb, babies want to keep warm and snuggled, so any cold placed near them will cause them to react and move away. A bag of frozen peas or ice works well for this technique. For warmth, try taking a shallow bath that only covers the bottom half of your belly or use a warm pack.

Change the placement of the heat and cold as the baby starts to shift to draw them toward the pelvis. This method can be used as often as you like as long as you remove the cold and heat when/if it becomes at all uncomfortable.

External cephalic version (ECV)

Performed by a health care provider after 37 weeks, an external cephalic version is a physical manipulation technique which can be used to manually turn your baby. During this procedure, a health care professional will apply pressure to your abdomen with their hands to try to get your baby to turn. Baby's heart rate is generally monitored and you may or may not be given medication to relax your muscles. However, an ECV isn't recommended for everyone; pregnant people with multiples or those with various complications would not be given an ECV.

What Happens if My Breech Baby Doesn't Turn?

While some breech babies may be delivered vaginally, most health care providers will suggest a C-section out of precaution. Risks of attempting a vaginal delivery with breech presentation include complications and problems with your baby's umbilical cord, which is why many health care professionals will opt for a C-section instead. If you find yourself with further questions or concerns about your baby's positioning, be sure to reach out to an OB-GYN, midwife, or health care provider for further guidance.

Additional reporting by Robin Elise Weiss, PhD, MPH .

If Your Baby Is Breech . ACOG.

Breech Presentation . National Library of Medicine.

Best Sleeping Positions While Pregnant . American Pregnancy Association.

Can I Sleep on My Back When I'm Pregnant? ACOG.

Beth Israel Lahey Health. Breech Presentation .

Acupuncture plus moxibustion to resolve breech presentation: a randomized controlled study . J Matern Fetal Neonatal Med.

External Cephalic Version . National Library of Medicine.

Breech Presentation . American Pregnancy Association.

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A comparison of risk factors for breech presentation in preterm and term labor: a nationwide, population-based case–control study

Anna e. toijonen.

1 Department of Obstetrics and Gynecology, University Hospital (HUS), University of Helsinki, Haartmaninkatu 2, 00290 Helsinki, Finland

3 School of Medicine, University of Helsinki, Helsinki, Finland

Seppo T. Heinonen

Mika v. m. gissler.

2 National Institute for Health and Welfare (THL), Helsinki, Finland

Georg Macharey

To determine if the common risks for breech presentation at term labor are also eligible in preterm labor.

A Finnish cross-sectional study included 737,788 singleton births (24–42 gestational weeks) during 2004–2014. A multivariable logistic regression analysis was used to calculate the risks of breech presentation.

The incidence of breech presentation at delivery decreased from 23.5% in pregnancy weeks 24–27 to 2.5% in term pregnancies. In gestational weeks 24–27, preterm premature rupture of membranes was associated with breech presentation. In 28–31 gestational weeks, breech presentation was associated with maternal pre-eclampsia/hypertension, preterm premature rupture of membranes, and fetal birth weight below the tenth percentile. In gestational weeks 32–36, the risks were advanced maternal age, nulliparity, previous cesarean section, preterm premature rupture of membranes, oligohydramnios, birth weight below the tenth percentile, female sex, and congenital anomaly. In term pregnancies, breech presentation was associated with advanced maternal age, nulliparity, maternal hypothyroidism, pre-gestational diabetes, placenta praevia, premature rupture of membranes, oligohydramnios, congenital anomaly, female sex, and birth weight below the tenth percentile.

Breech presentation in preterm labor is associated with obstetric risk factors compared to cephalic presentation. These risks decrease linearly with the gestational age. In moderate to late preterm delivery, breech presentation is a high-risk state and some obstetric risk factors are yet visible in early preterm delivery. Breech presentation in extremely preterm deliveries has, with the exception of preterm premature rupture of membranes, similar clinical risk profiles as in cephalic presentation.

Introduction

The prevalence of breech presentation at delivery decreases with increasing gestational age. At 28 pregnancy weeks, every fifth fetus lies in the breech presentation and in term pregnancies, less than 4% of all singleton fetuses are in breech presentation at delivery [ 1 , 2 ]. Most likely this is due to a lack of fetal movements [ 3 ] or an incomplete fetal rotation, since the possibility of a spontaneous rotation declines with increasing gestational age. Consequently, preterm labor itself is often associated with breech presentation at delivery, since the fetus was not yet able to rotate [ 4 – 9 ]. This fact makes preterm labor as one of the strongest risk factors for breech presentation.

Vaginal breech delivery in term pregnancies is not only associated with poorer perinatal outcomes compared to vaginal delivery with a fetus in cephalic presentation [ 6 , 10 , 11 ], but also it is debated whether the cause of breech presentation itself is a risk for adverse peri- and neonatal outcomes [ 3 , 12 , 13 ]. Several fetal and maternal features, such as fetal growth restriction, congenital anomaly, oligohydramnios, gestational diabetes, and previous cesarean section, are linked to a higher risk of breech presentation at term, and, furthermore, are associated with an increased risk for adverse perinatal outcomes [ 3 – 5 , 8 , 9 , 14 – 17 ].

The literature lacks studies on the risk factors of breech presentation in preterm pregnancies. It remains unclear whether breech presentation at preterm labor is only caused by the incomplete fetal rotation, or whether breech presentation in preterm labor is also associated with other obstetric risk factors. Most of the studies reviewing risk factors for breech presentation focus on term pregnancies. Our hypothesis is that breech presentation in preterm deliveries is, besides preterm pregnancy itself, associated with other risk factors similar to breech presentation at term. We aim to compare the risks of preterm breech presentation to those in cephalic presentation by gestational age. Such information would be valuable in the risk stratification of breech deliveries by gestational age.

Materials and methods

We conducted a retrospective population-based cross-sectional study. The population included all the singleton preterm and term births, from January 2004 to December 2014 in Finland. The data were collected from the national medical birth register and the hospital discharge register, maintained by the National Institute for Health and Welfare. All Finnish maternity hospitals are obligated to contribute clinical data on births from 22 weeks or birth weight of 500 g to the register. All newborn infants are examined by a pediatrician and given a personal identification number that can be traced in the case of perinatal mortality or morbidity. The hospital discharge register contains information on all surgical procedures and diagnoses (International Statistical Classification of Diseases and Related Health Problems 10th Revision, ICD-10) in all inpatient care and outpatient care in public hospitals.

Authorization to use the data was obtained from the National Institute for Health and Welfare as required by the national data protection law in Finland (reference number THL/652/5.05.00/2017).

The study population included all the women with a singleton fetus in breech presentation at the time of delivery. The control group included all the women with a singleton fetus in cephalic presentation at delivery. Other presentations were excluded from the study ( N = 1671) (Fig. 1 ). Gestational age was determined according to early ultrasonographic measurement which is routinely performed in Finland and it encompasses over 95% of the mothers, or if not available, to the last menstrual period. We excluded neonates delivered before 24 weeks of gestation and birth weight of less than 500 g, because the lower viability may have influenced the mode of the delivery or the outcome. The study population was divided into four categories according to the World Health Organization (WHO) definitions of preterm and term deliveries. WHO defines preterm birth as a fetus born alive before 37 completed weeks of pregnancy. WHO recommends sub-categories of preterm birth, based on gestational age, as extremely preterm (less than 28 pregnancy weeks), very preterm (28–32 pregnancy weeks), and moderate to late preterm (32–37 pregnancy weeks).

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Breech presentation for singleton pregnancies during the period of 2004–2014 in Finland

In our study, we assessed four factors that may be associated with breech presentation based on prior reports [ 3 – 5 , 14 , 17 – 20 ]. These factors were: maternal age below 25 and 35 years or more, smoking, pre-pregnancy body mass index (BMI) over 30, and in vitro fertilization. The following factors were also analyzed: nulliparity, more than three previous deliveries, and history of cesarean section. The obstetric risk factors including maternal hypo- or hyperthyroidism (ICD-10 E03, E05), gestational diabetes (ICD-10 O24.4) and other diabetes treated with insulin (ICD-10 O24.0), arterial hypertension or pre-eclampsia (ICD-10 O13, O14), and maternal care for (suspected) damage to fetus by alcohol or drugs (ICD-10 O35.4, O35.5) were assessed in the analysis. The variables that were also included in the analysis were: oligohydramnios (ICD-10 O41.0), placenta praevia (ICD-10 O44), placental abruption (ICD-10 O45), preterm premature rupture of membranes (PPROM) (ICD-10 O42), infant sex, fetal birth weight below the tenth percentile, fetuses with birth weight above the 97th percentile, and fetal congenital anomalies as defined in the register of congenital malformations.

The babies born in breech presentation from the four study groups were compared with the babies born in cephalic presentation with the equal gestational age, according to WHO classification. The calculations were performed using SPSS 19. Statistical differences in categorical variables were evaluated with the Chi-squared test or Fisher’s exact test when appropriate. We calculated odds ratios (ORs) with corresponding 95% confidence intervals (CIs) using binary logistic regression. Each study group was separately adjusted, according to gestational age at delivery, defined by WHO. The adjustment for the risk factors was done by multivariable logistic regression model for all variables. Differences were deemed to be statistically significant with P value < 0.05.

This analysis includes 737,788 singleton births, from these 20,086 were in breech presentation at the time of delivery. Out of all deliveries, 33,489 infants were born preterm. The prevalence of breech presentation at delivery decreased with the increase of the gestational age: 23.5% in extremely preterm delivery, 15.4% very preterm deliveries, and 6.7% in moderate to late preterm deliveries. At term, the prevalence of breech presentation at delivery was 2.5% (Fig. 1 ).

From all deliveries, 2056 fetuses were born extremely preterm (24 + 0 to 27 + 6 gestational weeks). The differences in the possible risk factors for breech presentation at delivery were higher odds of PPROM (aOR 1.39, 95% CI 1.08–1.79, P = 0.010) and a lower risk of placental abruption (aOR 0.59, 95% CI 0.36–0.98, P = 0.040). No statistically significant differences were observed for the other factors (Table (Table1, 1 , Figs. 1 , ,2, 2 , ,3, 3 , ,4 4 ).

Unadjusted and adjusted odds ratios for risk factors in singleton extremely preterm 24 + 0 to 27 + 6 weeks of gestational age fetuses in breech and in cephalic presentations during 2004–2014 in Finland

24–27 Weeks of gestation	Breech ( = 483)	Cephalic ( = 1573)	value	Odds ratio (95% Cl)	Adjusted odds ratio (95% Cl)
Maternal age < 25	17 (3.5%)	37 (2.4%)	0.153	1.51 (0.84–2.71)	1.56 (0.85–2.84)
Maternal age ≥ 35	129 (26.7%)	438 (27.8%)	0.606	0.94 (0.75–1.19)	0.94 (0.73–1.20)
Smoking	77 (15.9%)	251 (16.0%)	0.934	1 (0.76–1.32)	0.98 (0.74–1.30)
Maternal BMI ≥ 25	78 (16.10%)	262 (16.7%)	0.499	0.96 (0.76–1.32)	0.89 (0.62–1.27)
Maternal BMI ≥ 30	33 (6.8%)	104 (6.6%)	0.898	1.04 (0.69–1.55)	1.03 (0.61–1.75)
Nulliparity	221 (45.8%)	727 (46.2%)	0.409	0.98 (0.80–1.20)	0.91 (0.71–1.16)
Parity ≥ 3	66 (13.7%)	220 (14.0%)	0.983	0.97 (0.72–1.31)	1.01 (0.73–1.40)
Maternal hypothyroidism	6 (1.2%)	9 (0.6%)	0.159	2.19 (0.77–6.17)	2.15 (0.74–6.22)
Maternal hyperthyroidism	1 (0.2%)	3 (0.2%)	0.783	1.09 (0.11–10.46)	1.38 (0.14–13.62)
Pre-gestational diabetes treated with insulin	2 (0.4%)	6 (0.4%)	0.577	1.09 (0.22–5.40)	1.27 (0.55–2.96)
Gestational diabetes	20 (4.1%)	48 (3.1%)	0.222	1.37 (0.81–2.34)	1.42 (0.81–2.49)
Pre-eclampsia/hypertension	34 (7.0%)	84 (5.3%)	0.083	1.34 (0.89–2.03)	1.46 (0.95–2.24)
Previous cesarean section	64 (13.3%)	232 (14.7%)	0.294	0.88 (0.66–1.19)	0.85 (0.61–1.17)
IVF	17 (3.5%)	64 (4.1%)	0.828	0.86 (0.50–1.48)	0.94 (0.53–1.65)
Maternal care for (suspected) damage to fetus by alcohol/drugs	0 (0.0%)	3 (0.2%)	0.971
Placenta praevia	9 (1.9%)	29 (1.8%)	0.981	1.01 (0.48–2.15)	1.01 (0.47–2.18)
Placental abruption	20 (4.1%)	101 (6.4%)	0.040	0.63 (0.39–1.03)	0.59 (0.36–0.98)
PPROM	120 (24.8%)	308 (19.6%)	0.010	1.36 (1.07–1.73)	1. 39 (1.08–1.79)
Oligohydramnios	16 (3.3%)	45 (2.9%)	0.625	1.16 (0.65–2.08)	1.16 (0.64–2.11)
Congenital anomaly	122 (25.3%)	435 (27.7%)	0.242	0.88 (0.70–1.12)	0.87 (0.68–1.10)
Female sex	234 (48.4%)	734 (46.7%)	0.584	1.07 (0.88–1.32)	1.06 (0.86–1.30)
Birthweight < 10th percentile	47 (9.7%)	174 (11.1%)	0.486	0.87 (0.62–1.22)	1.16 (0.76–1.78)
Birthweight > 97th percentile	4 (0.8%)	15 (1.0%)	0.905	0.87 (0.29–2.63)	0.94 (0.30–2.89)

BMI body mass index, IVF in vitro fertilization, maternal intoxication, PPROM preterm premature rupture of membranes

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Prevalence of obstetric risk factors for breech presentation compared to cephalic by gestational age. PPROM preterm premature rupture of membranes, PROM premature rupture of membranes

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Obstetric risk factors for breech presentation with adjusted odds ratios by gestational age. PPROM preterm premature rupture of membranes, PROM premature rupture of membranes, aOR adjusted odds ratio

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The determinants of breech presentation by gestational age. PPROM preterm premature rupture of membranes, PROM premature rupture of membranes

The group of very preterm deliveries (28 + 0 to 31 + 6 gestational weeks) included 4582 singleton newborns. Breech presentation at delivery was associated with PPROM (aOR 1.61, 95% CI 1.32–1.96, P < 0.001), oligohydramnios (aOR 1.65, 95% CI 1.03–2.64, P = 0.038), fetal birth weight below the tenth percentile (aOR 1.57, 95% CI 1.19–2.08, P = 0.002), and maternal pre-eclampsia and arterial hypertension (aOR 1.31, 95% CI 1.04–1.66, P = 0.023). Details of risk factors in very preterm breech deliveries are described in Table Table2. 2 . The risk of placenta praevia as well as having a birth weight above the 97th percentile was lower in pregnancies with fetuses in breech rather than in cephalic presentation (Table (Table2, 2 , Figs. Figs.2, 2 , ,3, 3 , ,4 4 ).

Unadjusted and adjusted odds ratios for risk factors in singleton very preterm 28 + 0 to 31 + 6 weeks of gestational age fetuses in breech and in cephalic presentations during 2004–2014 in Finland

28–31 Weeks of gestation	Breech ( = 705)	Cephalic ( = 3877)	value	Odds ratio (95% Cl)	Adjusted odds ratio (95% CI)
Maternal age < 25	10 (1.4%)	108 (2.8%)	< 0.001	0.50 (0.26–0.96)	0.57 (0.29–1.10)
Maternal age ≥ 35	182 (25.8%)	954 (24.6%)	0.095	1.07 (0.89–1.28)	0.97 (0.80–1.18)
Smoking	105 (14.9%)	700 (18.1%)	0.064	0.79 (0.64–0.99)	0.81 (0.64–1.01)
Maternal BMI ≥ 25	109 (15.5%)	532 (13.7%)	0.124	1.15 (0.92–1.44)	1.24 (0.94–1.63)
Maternal BMI ≥ 30	33 (4.7%)	207 (5.3%)	0.053	0.87 (0.60–1.27)	0.64 (0.41–1.01)
Nulliparity	323 (45.8%)	1972 (50.9%)	0.121	0.82 (0.70–0.96)	0.86 (0.71–1.04)
Parity ≥ 3	96 (13.6%)	412 (10.6%)	0.202	1.33 (1.04–1.68)	1.19 (0.91–1.54)
Maternal hypothyroidism	8 (1.1%)	35 (0.9%)	0.888	1.26 (0.58–2.73)	1.06 (0.48–2.34)
Maternal hyperthyroidism	3 (0.4%)	6 (0.2%)	0.227	2.76 (0.69–11.05)	2.38 (0.58–9.72)
Pre-gestational diabetes treated with insulin	5 (0.7%)	16 (0.4%)	0.155	1.72 (0.63–4.72)	1.39 (0.88–2.18)
Gestational diabetes	59 (8.4%)	248 (6.4%)	0.086	1.34 (0.99–1.80)	1.31 (0.96–1.79)
Pre-eclampsia/hypertension	114 (16.2%)	514 (13.3%)	0.023	1.26 (1.01–1.57)	1.31 (1.04–1.66)
Previous cesarean section	128 (18.2%)	519 (15.2%)	0.443	1.23 (1.00–1.52)	1.10 (0.86–1.40)
IVF	22 (3.1%)	169 (4.4%)	0.122	0.71 (0.45–1.11)	0.68 (0.41–1.11)
Maternal care for (suspected) damage to fetus by alcohol/drugs	0 (0.0%)	9 (0.2%)	0.973
Placenta praevia	9 (1.3%)	133 (3.4%)	0.004	0.36 (0.18–0.72)	0.36 (0.18–0.72)
Placental abruption	32 (4.5%)	232 (6.0%)	0.225	0.75 (0.51–1.09)	0.79 (0.54–1.16)
PPROM	188 (26.7%)	764 (19.7%)	< 0.001	1.48 (1.23–1.78)	1.61 (1.32–1.96)
Oligohydramnios	26 (3.7%)	73 (1.9%)	0.038	2.00 (1.27–3.15)	1.65 (1.03–2.64)
Congenital anomaly	183 (26.0%)	946 (24.4%)	0.453	1.09 (0.90–1.31)	1.08 (0.89–1.30)
Female sex	315 (44.7%)	1739 (44.9%)	0.924	0.99 (0.84–1.17)	0.99 (0.84–1.17)
Birthweight < 10th percentile	93 (13.2%)	348 (9.0%)	0.002	1.54 (1.21–1.97)	1.57 (1.19–2.08)
Birthweight > 97th percentile	8 (1.1%)	97 (2.5%)	0.022	0.45 (0.22–0.92)	0.42 (0.20–0.89)

BMI body mass index, IVF in vitro fertilization, PPROM preterm premature rupture of membranes

The moderate to late preterm delivery group (32 + 0 to 36 + 6 gestational weeks) included 26,851 deliveries. Breech presentation in moderate to late preterm deliveries was associated with older maternal age (maternal age 35 years or more aOR 1.24, 95% CI 1.10–1.39, P < 0.001), nullipara (aOR 1.43, 95% CI 1.27–1.60, P < 0.001), maternal BMI less than 25 (maternal BMI ≥ 25 aOR 0.75, 95% CI 0.62–0.91, P = 0.004), previous cesarean section (aOR 1.31, 95% CI 1.12–1.53, P < 0.001), female sex (aOR 1.22, 95% CI 1.11–1.34, P < 0.001), congenital anomaly (aOR 1.37, 95% CI 1.22–1.55, P < 0.001), fetal birth weight below the tenth percentile (aOR 1.31, 95% CI 1.10–1.56, P = 0.003), oligohydramnios (aOR 3.60, 95% CI 2.63–4.92, P < 0.001), and PPROM (aOR 1.58, 95% CI 1.41–1.78, P < 0.001). Breech presentation decreased the odds of having a fetus with birth weight above the 97th percentile (aOR 0.60, 95% CI 0.42–0.85, P = 0.004) (Table (Table3, 3 , Figs. Figs.2, 2 , ,3, 3 , ,4 4 ).

Unadjusted and adjusted odds ratios for risk factors in singleton moderate to late preterm 32 + 0 to 36 + 6 weeks of gestational age fetuses in breech and in cephalic presentations during 2004–2014 in Finland

32–36 Weeks of gestation	Breech ( = 1854)	Cephalic ( = 24 997)	value	Odds ratio (95% Cl)	Adjusted odds ratio (95% CI)
Maternal age < 25	39 (2.1%)	741 (3.0%)	0.020	0.70 (0.51–0.97)	0.68 (0.48–0.94)
Maternal age ≥ 35	451 (24.3%)	5409 (21.6%)	< 0.001	1.16 (1.04–1.30)	1.24 (1.10–1.39)
Smoking	293 (15.8%)	4426 (17.7%)	0.139	0.87 (0.77–0.99)	0.91 (0.79–1.03)
Maternal BMI ≥ 25	202 (10.9%)	3359 (13.4%)	0.004	0.79 (0.68–0.92)	0.75 (0.62–0.91)
Maternal BMI ≥ 30	80 (4.3%)	1175 (4.7%)	0.120	0.91 (0.73–1.15)	1.26 (0.94–1.69)
Nulliparity	1048 (56.5%)	12,235 (48.9%)	< 0.001	1.36 (1.23–1.49)	1.43 (1.27–1.60)
Parity ≥ 3	158 (8.5%)	2665 (10.7%)	0.134	0.78 (0.66–0.92)	0.87 (0.73–1.04)
Maternal hypothyroidism	21 (1.1%)	259 (1.0%)	0.360	1.09 (0.70–1.71)	1.24 (0.78–1.96)
Maternal hyperthyroidism	6 (0.3%)	48 (0.2%)	0.100	1.69 (0.72–3.95)	2.06 (0.87–4.87)
Pre-gestational diabetes treated with insulin	5 (0.3%)	118 (0.5%)	0.066	0.57 (0.23–1.40)	0.76 (0.57–1.02)
Gestational diabetes	159 (8.6%)	2481 (9.9%)	0.099	0.85 (0.72–1.01)	0.86 (0.72–1.03)
Pre-eclampsia/hypertension	161 (8.7%)	2232 (8.9%)	0.394	0.97 (0.82–1.15)	0.93 (0.78–1.10)
Previous cesarean section	255 (13.8%)	3423 (13.7%)	< 0.001	1.01 (0.88–1.15)	1.31 (1.12–1.53)
IVF	75 (4.0%)	900 (3.6%)	0.854	1.13 (0.89–1.44)	0.98 (0.76–1.25)
Maternal care for (suspected) damage to fetus by alcohol/drugs	3 (0.2%)	39 (0.2%)	0.760	1.04 (0.32–3.36)	0.83 (0.25–2.76)
Placenta praevia	36 (1.9%)	624 (2.5%)	0.240	0.77 (0.55–1.09)	0.81 (0.58–1.15)
Placental abruption	27 (1.5%)	414 (1.7%)	0.763	0.88 (0.59–1.30)	0.94 (0.63–1.40)
PPROM	437 (23.6%)	3968 (15.9%)	< 0.001	1.63 (1.46–1.83)	1.58 (1.41–1.78)
Oligohydramnios	55 (3.0%)	191 (0.8%)	< 0.001	3.97 (2.93–5.38)	3.60 (2.63–4.92)
Congenital anomaly	362 (19.5%)	3690 (14.8%)	< 0.001	1.40 (1.24–1.58)	1.37 (1.22–1.55)
Female sex	890 (48.0%)	10,817 (43.3%)	< 0.001	1.21 (1.10–1.33)	1.22 (1.11–1.34)
Birthweight < 10th percentile	205 (11.1%)	2012 (8.0%)	0.003	1.42 (1.22–1.65)	1.31 (1.10–1.56)
Birthweight > 97th percentile	41 (2.2%)	1162 (4.6%)	0.004	0.46 (0.34–0.64)	0.60 (0.42–0.85)

The term and post-term group included 704,299 deliveries, among them 17,044 fetuses in breech presentation. The factors associated with breech presentation amongst these were: maternal age of 35 years or more (aOR 1.24, 95% CI 1.19–1.29, P < 0.001), nullipara (aOR 2.46, 95% CI 2.37–2.55, P < 0.001), maternal BMI less than 25 (BMI ≥ 25 aOR 0.90, 95% CI 0.85–0.96, P < 0.001), maternal hypothyroidism (aOR 1.53, 95% CI 1.28–1.82, P < 0.001), pre-gestational diabetes treated with insulin (aOR 1.24, 95% CI 1.00–1.53, P = 0.049), placenta praevia (aOR 1.45, 95% CI 1.11–1.91, P = 0.007), premature rupture of membranes (PROM) (aOR 1.58, 95% CI 1.45–1.72, P < 0.001), oligohydramnios (aOR 2.02, 95% CI 1.83–2.22, P < 0.001), congenital anomaly (aOR 1.97, 95% CI 1.89–2.06, P < 0.001), female sex (aOR 1.28, 95% CI 1.24–1.32, P < 0.001), and birth weight below the tenth percentile (aOR 1.18, 95% CI 1.12–1.24, P < 0.001) Table Table4 4 includes details for risk factors of term and post-term group (Figs. 2 , ,3, 3 , ,4 4 ).

Unadjusted and adjusted odds ratios for risk factors in singleton term pregnancies in breech and in cephalic presentations during 2004–2014 in Finland

≥ 37 Weeks of gestation	Breech ( = 17 044)	Cephalic ( = 687 255)	value	Odds ratio (95% Cl)	Adjusted odds ratio (95% CI)
Maternal age < 25	304 (1.8%)	15,496 (2.3%)	< 0.001	0.79 (0.70–0.88)	0.57 (0.51–0.64)
Maternal age ≥ 35	3313 (19.4%)	130,687 (19.0%)	< 0.001	1.03 (0.99–1.07)	1.24 (1.19–1.29)
Smoking	2593 (15.2%)	102,333 (14.9%)	0.845	1.03 (0.98–1.07)	1.00 (0.95–1.04)
Maternal BMI ≥ 25	1753 (10.3%)	79,114 (11.5%)	< 0.001	0.88 (0.84–0.93)	0.90 (0.85–0.96)
Maternal BMI ≥ 30	588 (3.4%)	25,854 (3.8%)	0.56	0.91 (0.84–0.99)	1.03 (0.93–1.14)
Nulliparity	10,387 (60.9%)	281,094 (40.9%)	< 0.001	2.25 (2.19–2.33)	2.46 (2.37–2.55)
Parity ≥ 3	910 (5.3%)	68,532 (10.0%)	< 0.001	0.51 (0.48–0.54)	0.75 (0.70–0.81)
Maternal hypothyroidism	131 (0.8%)	3146 (0.5%)	< 0.001	1.68 (1.41–2.01)	1.53 (1.28–1.82)
Maternal hyperthyroidism	22 (0.1%)	634 (0.1%)	0.082	1.40 (0.91–2.14)	1.46 (0.95–2.24)
Pre-gestational diabetes treated with insulin	24 (0.1%)	789 (0.1%)	0.049	1.23 (0.82–1.84)	1.24 (1.00–1.53)
Gestational diabetes	1447 (8.5%)	57,613 (8.4%)	0.418	1.01 (0.96–1.07)	1.02 (0.97–1.08)
Pre-eclampsia/hypertension	600 (3.5%)	21,627 (3.1%)	0.07	1.12 (1.03–1.22)	0.93 (0.85–1.01)
Previous cesarean section	1847 (10.8%)	73,575 (10.7%)	< 0.001	1.01 (0.97–1.06)	1.67 (1.58–1.76)
IVF	483 (2.8%)	14,393 (2.1%)	0.68	1.36 (1.24–1.49)	0.98 (0.89–1.08)
Maternal care for (suspected) damage to fetus by alcohol/drugs	6 (0.0%)	734 (0.1%)	0.001	0.33 (0.15–0.74)	0.27 (0.12–0.60)
Placenta praevia	55 (0.3%)	1418 (0.2%)	0.007	1.57 (1.20–2.05)	1.45 (1.11–1.91)
Placental abruption	23 (0.1%)	995 (0.1%)	0.496	0.93 (0.62–1.41)	0.87 (0.75–1.31)
PROM	582 (3.4%)	12,938 (1.9%)	< 0.001	1.84 (1.69–2.01)	1.58 (1.45–1.72)
Oligohydramnios	453 (2.7%)	7867 (1.1%)	< 0.001	2.36 (2.14–2.60)	2.02 (1.83–2.22)
Congenital anomaly	2846 (16.7%)	62 002 (9.0%)	< 0.001	2.02 (1.94–2.11)	1.97 (1.89–2.06)
Female sex	9321 (54.7%)	336,313 (48.9%)	< 0.001	1.26 (1.22–1.30)	1.28 (1.24–1.32)
Birthweight < tenthth percentile	2153 (12.6%)	63,826 (9.3%)	< 0.001	1.41 (1.35–1.48)	1.18 (1.12–1.24)
Birthweight > 97th percentile	237 (1.4%)	15,679 (2.3%)	< 0.001	0.60 (0.53–0.69)	0.75 (0.65–0.85)

BMI body mass index, IVF in vitro fertilization, PROM premature rupture of membranes

The main novel finding of our study was that the risk associations increase with each gestational age group after 28 weeks of gestation. With the exception of PPROM, the extremely preterm breech deliveries have similar clinical risk profiles as in cephalic presentation when matched for gestational age. However, as gestation proceeds, the risks start to cluster. In moderate to late preterm pregnancies as in term pregnancies, the breech presentation is a high-risk state being associated with several risk factors: PPROM, oligohydramnios, advanced maternal age, nulliparity, previous cesarean section, fetal birth weight below the tenth percentile, female sex, and fetal congenital anomalies. These are in line with the findings of previous studies [ 3 , 5 , 7 , 8 ], that associated breech presentation at term with obstetric risk factors. The prevalence of breech presentation was negatively correlated with the gestational age with a decline from 23.5% in extremely preterm pregnancies to 2.5% at term. The prevalence of breech presentation in preterm pregnancies observed in our trial is similar to that of comparable studies [ 1 , 2 ].

In extremely preterm deliveries, PPROM was the only risk factor for breech presentation and it stayed as a risk for breech presentation through the gestational weeks. This finding is comparable to the previous literature suggesting that PPROM occurs more often at earlier gestational age in pregnancies with the fetus in breech presentation compared with cephalic [ 21 , 22 ]. PPROM might prevent the fetus to change into cephalic presentation. Furthermore, Goodman and colleagues (2013) reported that in pregnancies with a fetus in a presentation other than cephalic had more complications such as oligohydramnios, infections, placental abruption, and even stillbirths. In our study, surprisingly, placental abruption seemed to have a negative correlation with breech presentation among extremely preterm deliveries. This inconsistency between our results and the literature might be due to the small number of cases. Many of the obstetric complications, for example gestational diabetes, late pre-eclampsia, and late intrauterine growth restriction develop during the second or the third trimester of the pregnancy which explains partially why the risk factors for breech presentation are rarer in extremely preterm deliveries.

In very preterm delivery, breech presentation was associated with PPROM, pre-eclampsia, and fetal birth weight below the tenth percentile. Fetal growth restriction is a known risk factor for breech presentation at term, since it is associated with reduced fetal movements due to diminished resources [ 23 – 25 ]. Furthermore, fetal growth restriction is known to be the single largest factor for stillbirth and neonatal mortality [ 26 – 30 ]. Maternal arterial hypertension disturbs placental function which might cause low birth weight [ 31 , 32 ]. Arterial hypertension and pre-eclampsia increased the risk for breech presentation in very preterm births, but not in earlier or later preterm pregnancies. This finding may be due to the bias that pre-eclampsia is a well-described risk factor for PPROM, fetal growth restriction, and preterm deliveries which are also independent markers for breech presentation itself [ 4 , 5 , 31 , 33 , 34 ]. The severity of early pre-eclampsia might affect the fetal wellbeing, reduce fetal movements and growth, which might reduce the spontaneous fetal rotation to the cephalic position [ 35 ]. In addition, the most severe cases might not reach older gestational age before the delivery.

The risk factor for breech presentation in moderate to late preterm breech delivery was PPROM, oligohydramnios, advanced maternal age, nulliparity, previous cesarean section, fetal birth weight below the tenth percentile, female sex, and fetal congenital anomalies. Oligohydramnios is a known significant risk factor for term breech pregnancies [ 25 ] and it is linked to the reduced fetal movements partly due to a restricted intrauterine space [ 24 , 35 ] and nuchal cords [ 35 ]. Additionally, oligohydramnios is associated with placental dysfunction, which might reduce fetal resources and thus has a progressive effect on the fetal movements and prevent the fetus from turning into cephalic presentation [ 3 , 4 , 18 ]. Fetal female sex in moderate to late preterm breech pregnancies remained as a risk factor, as identified previously for term pregnancies [ 3 – 5 ]. It has been debated whether this risk is due to a smaller fetal size or that female fetuses tend to move less [ 9 , 20 ]. The mothers of infants born in breech presentation in moderate to late preterm and term and post-term pregnancies seemed to be older and had an increased risk of having a fetus with a congenital anomaly. The advanced maternal age is associated with negative effects on vascular health, which may have an influence on the developing fetus and increase the incidence of congenital anomalies [ 19 , 34 , 36 ]. Furthermore, congenital anomalies may have a negative influence on fetal movements [ 19 , 35 ]. Whereas, the low birth weight was found as a risk for breech presentation, a birth weight above the 97th percentile was, coherently a protective factor for breech presentation in very to term and post-term pregnancies.

We found that in term pregnancies, breech presentation was associated with advanced maternal age, nulliparity, maternal hypothyroidism, pre-gestational diabetes, placenta praevia, PROM, oligohydramnios, fetal congenital anomaly, female sex of the fetus, and birth weight below the tenth percentile. A previous cesarean section is known to be positively related to the odds of having a fetus in breech presentation at term [ 5 , 14 ], and in our study, this risk factor started to show already in moderate to late preterm pregnancies. Instead of the scar being the cause of breech presentation, it is more likely that the women with a history of breech cesarean section have, during subsequent pregnancies, a fetus in breech presentation again or have a cesarean section for another reason [ 3 , 5 , 37 ]. Our data suggest that the advanced maternal age and nulliparity are the risks for breech presentation at term, but as well as in moderate to late preterm pregnancies. The tight wall of the abdomen and the uterus of nulliparous women might inhibit the fetus from rotating to cephalic presentation [ 9 ]. In a meta-analysis from 2017, older maternal age has been considered to increase the risk of placental dysfunction such as pre-eclampsia and preterm birth [ 36 ] that are also common risk factors for breech presentation [ 4 , 5 ]. Bearing the first child in older maternal age and giving birth by cesarean section may affect the decision not to have another child and might explain the higher rate of nulliparity among moderate to late preterm and term deliveries [ 1 ]. Our study found correlation between maternal hypothyroidism and breech presentation at term. Some studies have demonstrated an association between maternal thyroid hypofunction and adverse pregnancy outcomes such as pre-eclampsia and low birth weight which are, furthermore, risks for breech presentation and may explain partly the higher prevalence of maternal hypothyroidism in term breech deliveries [ 38 – 40 ]. However, the absence of screening of, for example, thyroid diseases may cause bias in the diagnoses.

Our study demonstrated that as gestation proceeds, more obstetric risk factors can be found associating with breech presentation. In the earlier gestation and excluding PPROM, breech deliveries did not differ in obstetric risk factors compared to cephalic. The risk factors in 32 weeks of gestational age are comparable to those in term pregnancy, and several of these factors, such as low birth weight, congenital anomalies and history of cesarean section, are associated with adverse fetal outcomes [ 1 , 4 , 5 , 8 , 14 , 17 ] and must be taken into account when treating breech pregnancies. Risk factors should be evaluated prior to offering a patient an external cephalic version, as the presence of some of these risks may increase the change of failed version or fetal intolerance of the procedure. This study had adequate power to show differences between the risk profiles of breech and cephalic presentations in different gestational phase. Further research, however, is needed for improving the identification of patients at risk for preterm breech labor and elucidating the optimal route for delivery in preterm breech pregnancies.

Our study is unique since it is the first study, to our knowledge, that compares the risks for breech presentation in preterm and term deliveries. The analysis is based on a large nationwide population, which is the major strength of our study. The study population included nearly 34,000 preterm births over 11 years in Finland and 737,788 deliveries overall. The medical treatment of pregnancies is homogenous, since there are no private hospitals treating deliveries. A further strength relates to the important information on the characteristics of the mother, for example smoking during pregnancy and pre-pregnancy body mass index. The retrospective approach is a limitation of the study, another one is the design as a record linkage study, due to which the variables were restricted to the data availability. Therefore, we were not able to assess, for example uterine anomalies or previous breech deliveries to the analysis.

Our results show that the factors associated with breech presentation in very late preterm breech deliveries resemble those in term pregnancies. However, breech presentation in extremely preterm breech birth has similar clinical risk profiles as in cephalic presentation.

Acknowledgements

Open access funding provided by University of Helsinki including Helsinki University Central Hospital.

Abbreviations

ICD-10	International Statistical Classification of Diseases and Related Health Problems 10th Revision
WHO	World Health Organization; BMI, body mass index
PPROM	Preterm premature rupture of membranes
OR	Crude odds ratio
Cl	Confidence interval
aOR	Adjusted odds ratio
PROM	Premature rupture of membranes

Author contribution

AT: Project development, manuscript writing. SH: Project development. MG: Data collection and analysis, manuscript editing. GM: Project development, manuscript editing.

This study was supported by Helsinki University Hospital Research Grants. Authorization to use of the data was obtained from the National Institute for Health and Welfare as required by the national data protection legislation in Finland (reference number THL/652/5.05.00/2017).

Compliance with ethical standards

We declare that we have no conflict of interest.

For this type of study, formal consent is not required. The National Institute for Health and Welfare authorized to use the data (reference number THL/652/5.05.00/2017).

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Anna E. Toijonen, Email: [email protected] .

Seppo T. Heinonen, Email: [email protected] .

Mika V. M. Gissler, Email: [email protected] .

Georg Macharey, Email: [email protected] .

Flip a Breech

Our webpage information is free to pregnant parents. Those of you that serve birthing parents can refer parents to this page to help them understand more about helping breech babies find room in the womb to turn head down; cite the source but don’t copy and paste, please.

Not every suggestion is appropriate for everyone who wants to help their baby turn. Be mindful of your health and needs so you can be safe and comfortable.

We don’t force babies to turn. Many pregnant people can make room for their baby to turn by themselves.

Read here for information to set your own plan
Or, order the Helping ebook and get a simplified set of instructions: Helping Your Breech Baby Turn
Find an Aware Practitioner for an in-person or online consultation
When is Breech an Issue?
Belly Mapping® Breech

When Baby Flips Head Down

Breech & Bicornuate Uterus
Breech for Providers
What if My Breech Baby Doesn't Turn?
Belly Mapping ®️ Method
After Baby Turns
Head Down is Not Enough
Sideways/Transverse
Asynclitism
Oblique Lie
Left Occiput Transverse
Right Occiput Anterior
Right Occiput Posterior
Right Occiput Transverse
Face Presentation
Left Occiput Anterior
OP Truths & Myths
Anterior Placenta
Body Balancing

Success is high with comprehensive body balancing

When any part of the pelvis is out of symmetry (crooked), then the ligaments supporting the womb are pulled and twisted too. The shape of the lower womb can be altered by this. The baby then has to find a way to fit that isn’t quite what nature intended. A twisted sacrum is common for breech (and posterior ).

Aligning the pelvis and relaxing tight uterine ligaments attached to the fascia near the pelvis are why chiropractic adjustments can often help breech babies flip to a head-down position.

Continue body balancing at home and with professionals after the baby turns head down. One thing I’ve observed is that when the breech baby does flip head down during the last month or two of pregnancy, the baby often moves to the head down, posterior (face forward) position.

Why is Baby Breech?

A breech position may be caused by an imbalance (asymmetry) in the mother’s pelvis or soft tissues. In other words, a tension or a twist in the lower uterine segment may be a “soft tissue” issue. This is not the woman’s fault, as we simply live in an era where a slight twist in the pelvis is common. Some causes of this may be:

Long car rides
Crossing our legs
Sports injuries
Abrupt stops (fender benders, etc.) torquing our torso
Carrying a toddler on a hip or other hip rotation causing activities over time
Serious falls
A neck or ankle injury

All of these can twist the pelvis and, in turn, twist the uterus, resulting in asymmetry. Many chiropractors can loosen the ligaments by doing the Webster Technique. Adjusting the sacrum, for both a vertical twist or a buckled (horizontal wrinkle) sacrum will let the baby put their head down more readily because the bones won’t be in the way. It may often take balancing muscles and ligaments (soft tissues) and the pelvic joint alignment (not one without the other) for success.

4 Steps For Turning a Breech Baby

If the baby is still breech after 30 or 32 weeks gestation:

Do self-care exercises, like the Three BalancesSM and Daily Activities and the releases in our Techniques pages.
Watch the Breech Consultation video below
Try our comprehensive, 6-day plan in Helping a Breech Baby Turn ebook
Seek professional help

Combine bodywork techniques with stretches on the Daily Activities page and, perhaps more importantly, the Weekly Activities page for a more comprehensive approach. Do the weekly activities every day for a week or two. Add Rest Smart SM but don’t expect your posture or that sitting up or lying on your left will turn baby itself.

Seek professional body work if you don’t get results after a week. After 34 weeks, call and book a session (or series of sessions) with someone who understands anatomy and fetal position, such as a Spinning Babies ® Aware Practitioner or a chiropractor/osteopath with Webster certification.

Note: Body balance issues are common for breech presentation, but are not the only reason! We suggest our weekly activities on a daily basis when the baby is not head down. For video detail and more explanation, you may want to buy our Daily Essentials video for enhancing range of motion and suppleness. You can also attend a Parent Class in person, taught by one of our Spinning Babies ® Certified Parent Educators .

These techniques are working for many who do them repeatedly, but be sure to ask your doctor if there is a medical reason you couldn’t try some of these suggestions. Each individual begins with their own level of need for balance. Some need a little help while others are overcoming twists or tightnesses that need just the right techniques.

At Spinning Babies ® , we offer techniques that work for most pregnancies with a breech position. Your doctor or midwife can monitor your progress and give further suggestions for your particular situation.

Breech Consultation Video

Spinning Babies ® creator Gail Tully shows a couple two types of inversions to do together for making room for their breech baby to turn head down or to make an external cephalic version easier for the doctor to perform.

Things to keep in mind:

Breech fetal position is common before 30 weeks and often okay at 32 weeks.
Trust your baby and trust your body, but let your body trust your habits too.
You can begin general balancing activities without knowing fetal position.
Do not use the Breech Tilt and Open-Knee-Chest in pregnancy unless you know baby is breech.
Put yourself in the position you want your baby to be in—head down!
Share your plan with your caregiver before you begin.
Talk to your baby, heart to heart, and tell your baby what you want – and ask your baby what he/she needs in this situation too.
When your womb is in balance, the baby is likely to flip head down spontaneously.
If the baby is still breech at 37 weeks or later, you may receive medical advice to have an external cephalic version (ECV) . Doing daily and weekly balancing activities before the ECV seems to help the procedure be more successful (and easier).
Is one or both of your twins breech? Check out my article on twins .

When should I start?

By 30-31 weeks, I highly recommend beginning the Forward-leaning Inversion position to encourage a head-down position.
From 30 weeks on you can start the 6-day plan in our Helping Your Breech Baby Turn ebook.
After 32-34 weeks, chiropractic adjustments are suggested.
34-35 weeks is the most successful time to use Moxibustion.

A detailed timeline is given for introducing techniques in pregnancies with breech babies. Look up your weeks gestation and do the suggestions for how to turn a breech baby listed there if you so choose. We have a handy exercise chart in our ebook as well.

Specific activities to try:

The womb has a septum or unusual shape
The baby is wrapped in a particular way by the cord (not as common as is claimed)
If you’re having twins and one twin blocks the flipping movement of the breech twin
Torsion causes reduced space in the lower uterine segment and it was not overcome or corrected by the woman’s selected activities (do more on the list above)
There’s uncorrected torsion in the lower uterine segment (find another body worker)
Intense core strength (6-pack belly)

Note: If you find that these exercises don’t work, it may increase emotional stress about having a breech birth. Whether or not the exercises work is not an indication of whether the vaginal breech birth will go smoothly or not.

Professional help for flipping a breech baby

For best success, begin professional help at 34 weeks. This opinion is shared by both Oxorn and Foote in Obstetrics Illustrated.

Professional help may include:

Maya massage
Chiropractic Webster Maneuver
Chiropractic adjustment
Therapeutic massage
Acupuncture
Fascial Therapy
Craniosacral
External cephalic version

You can see a list of professionals trained in our techniques in our Spinning Babies ® Aware Practitioner listings .

After the baby turns

If your baby was breech and is now head down, you can stop the inversions for a few days. Walk briskly for a mile or more every day for three days to get the baby’s head into the pelvis. After three days of walking, resume Forward-leaning Inversion once a day and the Abdominal and standing releases to continue the balance that will help the baby stay head down and rotate more readily once labor begins.

How can I tell when the baby flips?

You may or may not notice when the baby turns. You might be able to tell if the breech flips by feeling the feet kick where the head had been before. Usually, the strongest kicks are from the legs (not the arms) and will be high in the womb when the head is low.

An anterior placenta (one that gets on the front of the womb) can block the baby’s limb movement and confuse people who are trying to tell the baby’s position. More often, a mother will notice a difference in how she is carrying the baby.

Notice where your baby is kicking. If it is quite different and is now strong at the top of your womb, you may want to stop measures to flip the baby. If it stays the same, you might want to continue until you can get the midwife or doctor to verify the baby’s position.

I offer an article on Breech Belly Mapping or you can buy the Belly Mapping ® book.

What if I think my breech baby has flipped head down, but I’m not sure?

If you think the baby may have flipped head down, but you aren’t sure, you can either cease doing inversions until you do know for sure, or simply hold the Forward-leaning Inversion position for 30 seconds (or 3 long breaths).

If head down, will the baby flip breech if I do a Forward-leaning Inversion?

I think it’s unlikely that your baby will flip back to breech after balancing your body, unless the muscles and ligaments tighten up again. That said, keep your inversions short and do them only once a day. Don’t do the breech tilt if you think the baby may have gotten head down.

If you have a lot of amniotic fluid around your baby, so that a doctor needs to see you often, you should do other balancing activities like the Side-lying Release. Whether the baby flips on their own or with the help of an experienced midwife or doctor, the newly head-down baby is often in the right occiput posterior position .

A daily Forward-leaning Inversion can continue to help the baby get into an even better position for the start of labor. Remember, head down is only half the story!

If the breech baby doesn’t turn

Balancing techniques could help a vaginal breech birth go more smoothly. Always use physiologic breech birth practices (knee-elbow or hands-and-knees maternal position , hands-off the breech, natural childbirth, etc.).

Otherwise, a cesarean after labor begins gives the baby a bit of labor hormones to help transition into life outside the womb. Discuss these options with your midwife or doctor. There is currently better data in obstetrics to support physiological breech vaginal birth.

Consider that another week of healthy gestation, up to 40 weeks, has nothing but benefits for your baby. If you or your baby are not healthy, or if there is a prolapsed cord, you may need medical help.

Keep reading, keep balancing, and keep talking about what is beneficial for you and your baby with your provider. If you’d like to read more, here’s an article about the Window of Opportunity for Flipping Your Breech Baby .

Breech turning stories

Vbac-hopeful mama devotes a week to getting her baby head down.

I just wanted to let you know that I appreciated your help, and that at 34 weeks, me, my chiropractor, and my midwife are all pretty sure that the baby has flipped head down, to what your site basically calls a LOT position. It was a week-long process that wasn’t complete until I had done 3 Webster appointments, plus a bunch of inversions and doing your “daily activities” on your DVD every day, but it seems to have worked!

-Rebekah B.

A doula helps avoid a cesarean

Hi Gail. I was in your workshop in Farmington Hills. I’m a doula from Windsor, Ontario, and I really wanted to let you know that I have a client who is now due in 10 days and her OB was threatening a c-section as the baby was malpositioned [Erin later said the baby was breech]. But after we did the exercises, inversions, and fascial releases, we were able to make room for the baby to move. As of the last ultrasound, the baby is head down, and now mom will be able to have the delivery she wanted. Thank you so much for sharing your techniques.

-Erin M Seguin RMT, Doula

I just found out my baby is breech

I received this email from a woman who found out her baby is breech. You can read my response to her below.

I recently found out my baby is breech. This is a 2nd baby. My first was a very calm baby and was always head down. This one is QUITE active and apparently flipped in the 4 days between my midwife appointment and an ultrasound (they thought my placenta was low… it’s ok).

I exercise 3-5 times a week. I eat well and am in good shape. I am seeing a chiropractor … Initially, saw her for “shifty hips” that would pop out of joint… hasn’t happened since.

My only pregnancy problem (with both) is uterine irritability… I’ve tried cramp bark tea for this but usually the only solution is to sit down. If I don’t nip it in the bud, it progresses to quite strong contractions where I vomit. My uterus is often quite tight for hours on end when I am walking around or at work (I’m a nurse). I was much worse with my son (they kept thinking it was preterm labor but my cervix never opened). Of note, he was a very quick and easy labor/ birth (less than 4 hours)– maybe from all the uterine toning?

Here are my questions:

The Chiropractor did a Webster Maneuver once; usually she is cracking my back and neck and hips and such. Should she be doing Webster every week? What should I be expecting from her? I’ve never seen a Chiro before. I haven’t seen her yet since the baby flipped.
How does my uterine irritability play into all this? My midwife said I had very good abdominal tone also. Is this hurting things?
I’m being more diligent about my posture now and I’ll start some tilts/ inversions (already doing pelvic rocks). I’ll see if my husband can try the Rebozo sifting on me– would a Maya wrap sling work okay for a scarf?
I plan to have a home/water birth with a CNM. I know she won’t do breech births at home. I’d be willing to give it a go if there was a practitioner. My mom and grandma were both easy birthers and I’m shaped like my grandma who popped 10 kids out on the farm ?
Any other thoughts/suggestions? Thank you so much for your time. I better go do my pelvic rocks– the baby is dancing around in there!

Gail’s reply:

Your contraction symptoms and the baby’s breech position seem to match the picture of asymmetrical ligaments.

The Webster Maneuver would help the round ligaments.
Inversions will help the cervical ligaments first and then help the broad and round ligaments somewhat as well.
Pelvic adjustment releases any possible pulls on the ligaments supporting the womb from even a slight misalignment of the pelvic joints.
Get the abdomen ligaments relaxed and then supported. A pregnancy belt may help the looseness that makes it hard for the baby to have a toned slope to settle head down on.
When a baby is breech, the first action is to relax a twist in the womb using the above methods.

Now see my answers to your five questions below.

Question 1: The Chiropractor may have to adjust the pelvis in three ways

Suggest your chiropractor check:

The sacrum vertically (SI joints) for a twist at the ala
The sacrum horizontally for a buckle (wrinkle) that a sacral release will undo
The pubis symphysis

The Webster Maneuver is a gentle press on the round ligaments in a specific direction to soften the ligament. It takes just a few moments and will soften a cramp, spasm, or even “good tone” to allow the baby to flip past the ligaments into a head-down position. Releasing a kink or tightness in the round ligaments also helps the uterus become more symmetrical, which helps the baby into an ideal starting position for labor.

The Webster can be done repeatedly, weekly, or bi-weekly if in the last month or two. It is one step in helping a breech baby flip. Sometimes it is the only step needed, especially if repeated about 3-4 times. However, occasionally you may need more body work or self-care to flip a breech baby.

Question 2: Pelvic alignment and ligament release will help uterine irritability, especially getting the sacrum “unbuckled”

After a sacral release , you may wear a belt as much as possible to support a loose abdominal wall. There are other ways to help uterine “irritability” as well. Good tone may be too tight for a broad ligament. A tight broad ligament often goes along with an asymmetry in the round ligaments. Releasing it helps the baby turn past it.

Carol Phillips, DC, who taught me about the myofascial world, says that premature contractions are often solved by a sacral release ( standing sacral release ). The moms that I suggested to have this type of bodywork done have found it to work. I also suggest a high protein, whole foods diet with plenty of leafy greens, yellow veggies, Omega 3s, liquids, and salt-to-taste (basically a Brewer Diet and then some).

Question 3: Posture, inversions, and Rebozo

Using the Rest Smart ℠ positions will be helpful, of course, but probably not enough to help the baby flip on his or her own after 32-34 weeks. However, you should have a clear idea of several things you can do yourself, and the body work that will help.

Continue with inversions. I suggest the method of getting upside down shown in the video demonstration on this page .

The Jiggle;, a Belly Hug; or Manteada with a Rebozo helps maintain the balance and releases tension in the abdomen. Traditional Midwives of Mexico, Central America and some South American countries use a Rebozo (a long woven cloth) helps relax the broad ligament if you can relax your belly into it like a hammock and your partner can lift the weight of the baby off your spine without scrunching into it. Start slowly and do short jiggles until your involuntary muscles can relax (about 3 minutes). Repeat daily as possible.

Traditional Russian midwives use a similar cloth in other ways to help balance the body.

Question 4: Finding an attendant for a vaginal breech birth

Your clarity on your ability to birth a breech baby is one of several aspects of safety for breech vaginal birth . An important physical assessment will help determine if a vaginal breech birth might be safe in your situation. Searching out an experienced midwife or physician in breech birth is a challenge, but a necessary one if you decide to have your baby naturally at home or in the hospital.

You will have to ask at midwifery circles, home birth support groups, cesarean prevention groups, and teaching hospitals for referrals. Having an experienced person reduces the risk of breech birth but doesn’t eliminate it altogether.

Question 5: Besides fascial therapy for uterine “irritability,” I suggest the following:

Drink 3-4 cups of bulk red raspberry leaf tea daily (if you don’t have sensitivities to dried herbs, of course). Use 2 tablespoons in a wire mesh strainer and fill a quart jar with almost boiling water to steep for 5-6 minutes. Remove the herbs and drink hot or cold, and straight or with a splash of apple juice.
Eat plenty of protein, but watch the peanut butter (it’s hard for a pregnant liver to process).
Check for a calcium magnesium supplement that is easy to absorb.
Wear a snug pregnancy belt.

Final thoughts on flipping a breech

The timing of body balance can allow baby to turn or be too late. Some will wait to try these techniques until they are already 34 weeks pregnant and for them, that may be too late. Others do one technique at 40 weeks and it works. How do you know which you will be?

Helping your baby flip head down is mostly a matter of finding what your womb needs for your baby, and listening to what your baby is telling you is needed in order to flip.

I believe you will do what your being feels comfortable doing. If not changing what you are doing is most comfortable to you, that’s ok. If exploring new activities, possibilities and people is comfortable, you will feel more ease in exploring your body and the balance this approach brings.

Think about a moment next year when you are looking back at this time. I hope you feel nurtured, bold, and proud of yourself for trying the things you felt were fine for you and in the amount of effort that was empowering to you.

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IMAGES

31 Week Twin Pregnancy Update
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Understanding Breech position in pregnancy
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Breech Pregnancy: 8 Important Questions, Answered!
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BREECH PRESENTATION PART-2| DIAGNOSIS
Breech presentation in Tiffa scan

COMMENTS

Breech Position: What It Means if Your Baby Is Breech
Very rarely, a problem with the baby's muscular or central nervous system can cause a breech presentation. Having an abnormally short umbilical cord may also limit your baby's movement. Smoking. Data shows that smoking during pregnancy may up the risk of a breech baby.
Breech position baby: How to turn a breech baby
At 28 weeks or less, about a quarter of babies are breech, and at 32 weeks, 7 percent are breech. By the end of pregnancy, only 3 to 4 percent of babies are in breech position. At term, a baby in breech position is unlikely to turn on their own. ... Turning foetal breech presentation at 32-35 weeks of gestational age by acupuncture and ...
Breech Baby: Causes, Complications, and Turning
Overview. About 3-4 percent of all pregnancies will result in the baby being breech. A breech pregnancy occurs when the baby (or babies!) is positioned head-up in the woman's uterus, so the feet ...
If Your Baby Is Breech
In the last weeks of pregnancy, a fetus usually moves so his or her head is positioned to come out of the vagina first during birth. This is called a vertex presentation. A breech presentation occurs when the fetus's buttocks, feet, or both are in place to come out first during birth. This happens in 3-4% of full-term births.
Breech Presentation
Breech Births. In the last weeks of pregnancy, a baby usually moves so his or her head is positioned to come out of the vagina first during birth. This is called a vertex presentation. A breech presentation occurs when the baby's buttocks, feet, or both are positioned to come out first during birth. This happens in 3-4% of full-term births.
Fetal Presentation, Position, and Lie (Including Breech Presentation)
In breech presentation, the presenting part is a poor dilating wedge, which can cause the head to be trapped during delivery, often compressing the umbilical cord. For breech presentation, usually do cesarean delivery at 39 weeks or during labor, but external cephalic version is sometimes successful before labor, usually at 37 or 38 weeks.
Breech Presentation: Types, Causes, Risks
Learn more about the types, causes, and risks of breech presentation, along with how breech babies are typically delivered. ... These are usually scheduled between 38 and 39 weeks of pregnancy ...
What happens if your baby is breech?
Turning a breech baby. If your baby is in a breech position at 36 weeks, you'll usually be offered an external cephalic version (ECV). This is when a healthcare professional, such as an obstetrician, tries to turn the baby into a head-down position by applying pressure on your abdomen. It's a safe procedure, although it can be a bit uncomfortable.
Breech presentation
Summary. Breech presentation refers to the baby presenting for delivery with the buttocks or feet first rather than head. Associated with increased morbidity and mortality for the mother in terms of emergency cesarean section and placenta previa; and for the baby in terms of preterm birth, small fetal size, congenital anomalies, and perinatal ...
Fetal presentation before birth
Frank breech. When a baby's feet or buttocks are in place to come out first during birth, it's called a breech presentation. This happens in about 3% to 4% of babies close to the time of birth. The baby shown below is in a frank breech presentation. That's when the knees aren't bent, and the feet are close to the baby's head.
Breech: Types, Risk Factors, Treatment, Complications
At full term, around 3%-4% of births are breech. The different types of breech presentations include: Complete: The fetus's knees are bent, and the buttocks are presenting first. Frank: The fetus's legs are stretched upward toward the head, and the buttocks are presenting first. Footling: The fetus's foot is showing first.
When Is Breech an Issue?
During the month before 30 weeks, about 15% of babies are breech. Since breech baby's spine is vertical, the womb is "stretched" upwards. We expect babies to turn head down by 28-32 weeks. Breech may not be an issue until 32-34 weeks. If you know your womb has an unusual limitation in shape or size, such as a bicornate uterus then begin ...
Breech Baby: Causes, ECV & Delivery
This is common in early pregnancy. Most babies that are breech will turn themselves by about 36 to 37 weeks, so that they are head-down, ready for birth. This is the best position for a baby to be in near the end of pregnancy. Sometimes, though, babies do not turn head-down. Around 3 to 4 babies in every 100 remain breech.
Fetal Presentation, Position, and Lie (Including Breech Presentation)
Toward the end of pregnancy, the fetus moves into position for delivery. Normally, the presentation is vertex (head first), and the position is occiput anterior (facing toward the pregnant person's spine) and with the face and body angled to one side and the neck flexed. Variations in fetal presentations include face, brow, breech, and shoulder.
Breech baby at the end of pregnancy
Babies lying bottom first or feet first in the uterus (womb) instead of in the usual head-first position are called breech babies. Breech is very common in early pregnancy, and by 36-37 weeks of pregnancy, most babies turn naturally into the head-first position. Towards the end of pregnancy, only 3-4 in every 100 (3-4%) babies are in the breech ...
Breech pregnancy and safe birthing options
If your baby is lying bottom-down in your uterus (womb), this is called the breech position. It is common for a baby to be in a breech position before 35 to 36 weeks of pregnancy. Most babies turn to a head-down position before the last month of pregnancy. About 3 in every 100 babies are lying in a breech position at the end of pregnancy.
Signs That Your Baby Has Turned Into a Head-Down Position
At 28 weeks, around 25% of babies are breech ... wait until you are at least 30 weeks pregnant. Lie down in bed or on the couch, and use a washable marker or finger paint to gently mark where you ...
How to Get Baby Head Down: Positions to Try
Heat and Cold. The strategy for using heat and cold is to put cold near where the baby's head is currently (at the top of the uterus) and warmth where you want the head to go (near the bottom of ...
A comparison of risk factors for breech presentation in preterm and
Introduction. The prevalence of breech presentation at delivery decreases with increasing gestational age. At 28 pregnancy weeks, every fifth fetus lies in the breech presentation and in term pregnancies, less than 4% of all singleton fetuses are in breech presentation at delivery [1, 2].Most likely this is due to a lack of fetal movements [] or an incomplete fetal rotation, since the ...
PDF Breech baby at the end of pregnancy
babies. Breech are is very breech common in early pregnancy, and by 36-37 weeks of pregnancy, most babies A breech turn naturally baby into the may head-first position. be lying 100 in one of Towards the end of pregnancy, only 3-4 in every (3-4%) babies are the in the breech position. A breech baby may be lying in one of the following ...
Flip A Breech
By 30-31 weeks, I highly recommend beginning the Forward-leaning Inversion position to encourage a head-down position. From 30 weeks on you can start the 6-day plan in our Helping Your Breech Baby Turn ebook. After 32-34 weeks, chiropractic adjustments are suggested. 34-35 weeks is the most successful time to use Moxibustion.
Breech birth
A breech birth is when a baby is born bottom first instead of head first, as is normal. [1] Around 3-5% of pregnant women at term (37-40 weeks pregnant) have a breech baby. [2] Due to their higher than average rate of possible complications for the baby, breech births are generally considered higher risk. [3] Breech births also occur in many other mammals such as dogs and horses, see ...

If Your Baby Is Breech

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Breech Births

What are the different types of breech birth presentations?

What causes a breech presentation?

How is a breech presentation diagnosed?

Can a breech presentation mean something is wrong?

Can a breech presentation be changed?

Medical Techniques

ECV will not be tried if:

Complications of EVC include:

Vaginal delivery versus cesarean for breech birth?

What are the risks and complications of a vaginal delivery?

When is a cesarean delivery used with a breech presentation?

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Disclosures

Christine L. Roberts, MBBS, FAFPHM, DrPH

Jonathan Morris, MBChB, FRANZCOG, PhD

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Rhona Hughes, MBChB

Brian Peat, MD

Lelia Duley, MBChB

Justus Hofmeyr, MD

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